BY DAY 3 OF WEEK 3:
Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy.
Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected.
What are the impacts, and how might policy address these competing needs?
Be specific and provide examples.
BY DAY 6 OF WEEK 3
Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.
Table of Contents
ToggleMain Post
A nursing policy is a set of rules that all hospital staff must follow to ensure safe and effective patient care, regardless of their education or experience. These policies are crucial to maintaining consistency and safety in healthcare. One important area of nursing policy involves balancing the right number of nurses with the needs of patients. The American Nurses Association (2015) highlights that nurses have a duty not only to their patients but also to each other. This responsibility includes following ethical guidelines, doing what’s right, and showing compassion, even when it requires personal sacrifices, such as missing breaks or time with family.
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Concerns about nursing shortages have been around for years. Twigg et al. (2010) predicted a shortage of up to 60,000 nurses in Australia, and today, Turale and Meechamnan (2022) report a global shortage of over 5 million nurses. One critical nursing policy focuses on determining how many nurses are needed for each patient, ensuring safe care. Without enough nurses, the risk of patient care errors increases significantly.
When nurses are overworked, mistakes in patient care become more common. According to Walden University (2012), a shortage of nurses can lead to premature patient discharges, where patients are sent home before they are ready and expected to manage their recovery alone, instead of receiving proper care in rehab or skilled nursing facilities. Ross (2022) also points out that when there aren’t enough nurses, staff are often asked to take on additional tasks, leading to more errors and less time for teamwork. Hospital managers expect their staff to follow established nursing policies, but these rules can be difficult to implement when there aren’t enough nurses to go around. As a result, policies need to adapt to ensure patient care is safe, especially during times of nursing shortages.
For nursing students or professionals looking to enhance their understanding of these challenges, there are a variety of resources available, including online nursing papers, nursing assignments, nursing exams, and custom nursing papers. These can help provide insights into nursing research and offer practical knowledge that can be applied in real-world settings. Accessing best nursing papers, top nursing essays, and online nursing essays can be beneficial for those who want to improve their understanding of how nursing policies impact patient care and staff well-being. Online nursing courses and research materials can also support the development of new nursing policies to address current staffing issues and improve overall healthcare outcomes.
By staying informed through nursing papers and nursing essays, healthcare professionals can better understand the importance of nursing staffing policies and advocate for changes that will improve patient safety and support their colleagues in the workplace.
References:
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Ross, J. (2022). Nursing Shortage Creating Patient Safety Concerns. Journal of PeriAnesthesia Nursing, 37(4), 565–567. https://doi.org/10.1016/j.jopan.2022.05.078Links to an external site.
Twigg, D., Duffield, C., Thompson, P. L., & Rapley, P. (2010). The impact of nurses on patient morbidity and mortality — the need for a policy change in response to the nursing shortage. Australian Health Review, 34(3), 312–316. https://doi.org/10.1071/AH08668Links to an external site.
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.
Walden University, LLC. (Producer). (2012). Ethical, Moral, and Legal Leadership [Video file]. Baltimore, MD: Author.
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Collapse SubdiscussionDallas Wilcox Week 3 Response #1 to Jan Griffin
Jan, I completely agree with your observations about the significant challenges caused by the ongoing nursing shortage. You’ve highlighted some important points, particularly the impact of these shortages on both nurses’ ability to be supportive colleagues and the overall quality of patient care.
I also believe that the nursing shortage is worsened by several competing needs that nurses face in their personal and professional lives. Nurses are often required to work long, demanding 12-hour shifts, deliver excellent patient care, and do so with little time to question or address the compensation they receive for such challenging work. A major factor driving nurses out of the profession faster than new nurses are entering is the increasing burden of documentation. Healthcare facilities are demanding more and more documentation to protect themselves from legal liabilities, and this pressure, along with the rising demands of technology, documentation, and concerns over liability, is pushing many nurses to leave the field (Haddad et al., 2022). Clearly, there needs to be a way to better support nurses and motivate them to meet these constant and growing demands.
To tackle the nursing shortage, several policy changes could help alleviate these challenges. For instance, increasing funding for nursing education pathways, providing resources to support childcare for nurses, and offering financial aid for nursing support staff to return to school and obtain licensure would all be beneficial (Cusick et al., 2022). These steps could help ease some of the burdens and encourage more nurses to stay in the profession.
Additionally, I would recommend conducting a thorough review of the leadership overseeing nursing staff in healthcare facilities. Often, administrators and leaders may not fully understand or have first-hand experience with the day-to-day challenges that nurses face. As Kelly and Porr (2018) discuss, leaders who approach nursing from a purely business perspective may not appreciate the complexities of nurses’ roles, leading to increased burnout and contributing to the nursing shortage.
Thank you for starting this important conversation, and I hope my insights into the competing needs within the nursing field add value to this discussion. For those interested in further exploring these issues, nursing essays, nursing research, and custom nursing papers can provide deeper insights into the factors driving the nursing shortage and potential solutions to improve nurse retention and patient care.
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References
Cusick, J. V., Nadeau, S. S. M., Shepherd Director, M., Lofgren, E. A., Zhavoronkova, M., Bass, J., Adhikari, J., Sozan, M., Schneider, A., Schweitzer, J., & Mirza, Z. (2022, June 7). How to ease the nursing shortage in America. Center for American Progress. https://www.americanprogress.org/article/how-to-ease-the-nursing-shortage-in-america/Links to an external site.
Haddad, L., Annamaraju, P., & Toney-Butler, T. (2022, February). Nursing Shortage. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books
Kelly, P., & Porr, C. (2018, January 31). Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice. OJIN. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
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Collapse SubdiscussionJulie Robinson Hello Jan and the class,
I want to express my gratitude for your post. I truly value your emphasis on the importance of nurses acting ethically and being good not only to their patients but also to their colleagues. It’s crucial that nurses not only care for their patients but also have a say in healthcare services. Unfortunately, many registered nurses remain silent and hesitate to voice their professional opinions (Kelly and Porr, 2018). They often believe that their concerns won’t be taken seriously or that no one will pay attention to them. This culture of silence has inadvertently given rise to a culture of complacency and perpetuated the suppression of nursing expertise (Kelly and Porr, 2018).
Understanding the ethical consequences of every nursing action is a vital aspect of ethical awareness. One effective strategy to empower nurses to act as moral agents and provide patients with safe and ethical care is to enhance their ethical awareness (Milliken, 2018).
Once again, thank you for your post. I genuinely appreciate reading your discussions each week. I wish you a wonderful day.
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References
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man06Links to an external site.
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man01Links to an external site.
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Collapse SubdiscussionIris Cornell Jan response from the instructor
Jan thanks for sharing. What can you do as a nurse to help balance the competing needs while addressing any ethical shortcomings of existing policies?
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Collapse SubdiscussionJan Griffin Response 2
Dr. Cornell-
Dear Dr. Cornell,
When discussing the challenges nurses face related to nurse-to-patient ratios and their compensation, hospital policies play a critical role in protecting both patients and nurses. A key to addressing these challenges is finding a balance that ensures both patient safety and nurse well-being. Nurses often become highly skilled at their tasks, performing them almost automatically. However, this familiarity can sometimes lead to errors. It’s essential to continuously raise nurses’ awareness of best practices and ensure that safe and effective care is always the priority (Milliken, 2018).
Many healthcare institutions have policies that establish appropriate nurse-to-patient ratios, tailored to different types of care units. Some states have taken it a step further by introducing staffing policies that align nurse numbers with the specific level of care a patient requires (Shin et al., 2018). However, the nursing profession is currently facing significant strain, with more patients in need of care than there are available nurses. This imbalance has exposed gaps in current policies, underscoring the need for new nursing policies that address these challenges more effectively. The creation and proper implementation of these policies are crucial to improving patient safety and nurse retention during this difficult time.
As a nurse, there are steps you can take to help address these issues while navigating the ethical dilemmas surrounding existing policies. Advocating for patient safety and pushing for appropriate nurse-to-patient ratios within your healthcare facility is an important first step. Additionally, supporting and participating in efforts to revise policies to better reflect the current realities of the nursing field is vital. By actively engaging in these discussions and advocating for policy changes, you can help improve working conditions for nurses and ensure that patients continue to receive the best care possible.
For those looking to explore these challenges further, nursing essays, nursing research, and custom nursing papers can offer deeper insights into the critical role nurse staffing policies play in both patient care and nurse welfare. These resources can help inform strategies for policy improvement and support efforts to reduce the strain on the nursing profession.
Thank you for considering these insights. I look forward to your response.
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References:
Milliken, A. (2018). Ethical Awareness: What It Is and Why It Matters. Online Journal of Issues in Nursing, 23(1), 2. https://doi.org/10.3912/OJIN.Vol23No01Man01Links to an external site.
Shin, S., Park, J.-H., & Bae, S.-H. (2018). Nurse staffing and nurse outcomes: A systematic review and meta-analysis. Nursing Outlook, 66(3), 273–282. https://doi.org/10.1016/j.outlook.2017.12.002Links to an external site.
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Collapse SubdiscussionJeanne Baleng Okuwobi Module II. Response I
Hello Jan,
I agree that the nurses’ workload and ability to multitask can facilitate medical errors. A source states that A typical RN in a hospital setting will render direct patient care by cleaning and turning patients, resuscitating patients, assessing vital signs, starting intravenous lines, administering medications, taking verbal telephone orders from physicians, charting and documentation, teaching, answering telephones, and transporting patients to other areas of the hospital only to cite some of the significant tasks., but yet nurses do not get the respect they deserve. (Yen et al., 2018). In addition, to the risk of errors, the strains that workload put on nurses lead to burnout and emotional and mental despair. Thus, many nurses have resigned from nursing, and many are still planning to leave the field of nursing, which is causing more shortages. According to experts, “The new shortage will be bigger than previous ones because many nurses already resign from the profession, and over 34 percent of nurses are still planning to resign from their role by the end of 2022” (Kreimer, 2022). I believe that healthcare organizations need to do more to help the shortage. The workload, including unsafe assignments, the lack of nursing assistants, the lack of resources ( such as adequate PPE and staff social support, and the poor image of the nurse are some of the significant criteria driving nurses away from the field.
References
Yen, P. Y., Kellye, M., Lopetegui, M., Saha, A., Loversidge, J., Chipps, E. M., Gallagher-Ford, L., & Buck, J. (2018). Nurses’ Time Allocation and Multitasking of Nursing Activities: A Time Motion Study. AMIA … Annual Symposium proceedings. AMIA Symposium, 2018, 1137–1146.
Kreimer, S. (2022, April 5). Nursing shortage looms large and projected to intensify in next 18
months: Report. Fierce Healthcare. Available from
intensify-next-year-and-
halfreport#:~:text=Burnout%20and%20stress%20from%20working,nursing%20hiring%20pl
atform%20Incredible%20Health
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Collapse SubdiscussionElin Danelian Week 3 Discussion- Response 1 to Jan Griffin
Hello Jan,
Thank you for your insightful post. I completely agree that when there is a nursing shortage, patient outcomes can be significantly impacted in a negative way. Healthcare institutions must be deeply concerned about the growing demands and challenges associated with healthcare shortages. The healthcare industry is constantly evolving, and working conditions in hospitals are becoming more stressful and demanding. As a result, healthcare employees are at a higher risk of experiencing serious distress, burnout, and both physical and mental health issues (Portoghese et al., 2014).
Creating a healthy work environment and ensuring adequate staffing levels are essential for balancing the competing needs of healthcare organizations. These factors are crucial not only for patient safety but also for maintaining the well-being of the entire healthcare workforce. However, addressing the nursing shortage can be challenging, especially when institutions are tasked with providing enough resources despite limited budgets. Safarani et al. (2018) suggest that one possible solution is to divide the budget among the three core missions of teaching hospitals—treatment, research, and education. This approach could help ensure that resources are available to support healthcare workers and improve overall patient care.
For those interested in further exploring these issues, nursing papers, nursing research, and nursing assignments can provide valuable insights into strategies for tackling the nursing shortage and improving the work environment for healthcare professionals. Additionally, custom nursing papers and online nursing essays can offer deeper perspectives on how hospitals and healthcare systems can better allocate resources to address both patient and staff needs effectively.
References
Portoghese, I., Galleta, M., Coppola, R., Finco, G., & Campagna, M. (2014). Burnout and Workload Among Health Care Workers: The Moderating Role of Job Control, 25(1), 19-21. https://doi.org/10.1016/j.shaw.2014.05.004
Safarani, S., Ravaghni, H., Raeissi, P., & Maleki, M. (2018). Financial challenges of teaching hospitals and providing solutions. Journal Of Education and Health Promotion. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332650/
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Collapse SubdiscussionOluwashola Adebola Adeniji Response #1 to Jan Griffin
Hello Jan,
Some conflicting requirements may impact policy development in the healthcare industry. For example, the demands of the healthcare workers, patients, and resources may influence policy formation since the policy’s objective should fit with conflicting needs. For example, a policy that solves the problem of not having enough nurses in a hospital at a low cost could meet the needs of both the staff and the patients. (Lopez et al., 2015) say that a healthcare organization’s ability to make good use of its staff helps it provide quality, quantity, and cost-effective care.
A strong match between an organization’s operational costs and patients’ demands in terms of quality and safe treatment may have an influence on nurse shortage as a national healthcare problem. So, hospitals and other healthcare facilities are looking into ways to balance the number of nurses on staff with the needs of patients. This approach will help them to retain the sustainability of operating expenses and deliver excellent and safe patient care (Van den Oetelaar et al, 2016).ReferencesLivanos, N. (2018). A Broadening Coalition: Patient Safety Enters the Nurse-To-Patient Ration Debate. Journal of Nursing Regulation, 9(1), 68-70.
Lopes, M., Almeida, A., & Almada-Lobo, B. (2015). Handling healthcare workforce planning with care: where do we stand? Human Resources for Health13:38.
van den Oetelaar, van Stel, H., Van Rhenen W, et al. (2016). Balancing nurses’ workload in hospital wards: study protocol of developing a method to manage workload. BMJ Open, 6 (11), e012148
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Collapse SubdiscussionPaulphielle Mcqueen Response #2 to Jen
Jen, I agree that policies should be changed to show how to manage patient care with the high nursing shortage we currently have nationwide. With the nursing shortage especially at my hospital there has been an extreme number of increased “Variance” reports. Some ways to decrease the nursing shortage and make working conditions more safe for nurses and patients is to adjust nursing protocols to meet nurses needs, listen to nurses concerns and even push for more nurse educators (Jean, 2022). If some these changes could be implemented it could potentially aid in decreasing the turn over in nurses. The World Health Organization (WHO) has predicted that because of the shortage of nurses currently there will be an even larger shortage in the coming years if nothing is implement to help the nurses now (Buchan, 2008).
Reference
Buchan J, Aiken L. Solving nursing shortages: a common priority. J Clin Nurs. 2008 Dec;17(24):3262-8. doi: 10.1111/j.1365-2702.2008.02636.x. PMID: 19146584; PMCID: PMC2858425.
Jean, J. (2022, December 14). Strategies to combat the nursing shortage. NurseJournal. https://nursejournal.org/articles/proven-strategies-to-survive-the-nursing-shortage-2022/Links to an external site.
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Collapse SubdiscussionBeth Howell Week 3 Main Post Beth Howell
How Competing Needs May Impact the Development of Policy
The nursing shortage and the competing needs associated with it have significantly impacted the development of nursing policy. The American Nurses Association (ANA) has established a Code of Ethics to guide nurses, along with interpretive statements to help clarify the ethical standards for nursing practice (ANA, 2015). Provision Six of this code emphasizes that nurses are responsible for assessing the ethics of care delivery, including ensuring safe care with appropriate staffing levels. Nurses are expected to raise concerns when ethical care is not being delivered or when improvements are needed. Provision Two reinforces that the patient’s needs must always be the primary concern, and Provision Seven stresses that nurses have an obligation to advocate for the patient’s interests, which includes participating in policymaking that affects patient care (ANA, 2015).
The Nursing Shortage and Competing Needs
Nursing is the largest group of healthcare professionals (Haddad et al., 2022). Many factors influence the cost of nursing, including training, recruitment, overtime, and retention. One of the biggest competing needs in nursing is balancing the cost of recruiting and maintaining a strong, qualified nursing staff with budgetary constraints. Staffing can be difficult to predict, as it is influenced by patient acuity and economic conditions (Parsons, 2019). Lower nurse staffing ratios are less expensive but can lead to overtime, increased errors, and nursing dissatisfaction (Haddad et al., 2022). Additionally, the use of agency nurses—who are more costly than full-time staff—adds to the financial strain. Including nurses’ perspectives on safe staffing and ethical care is essential for improving nursing satisfaction, even in a cost-containment environment (Kelly & Poor, 2018). In summary, financial constraints and the need to reduce medical costs are significant competing needs in healthcare that directly impact nursing policy.
Policy to Address Competing Needs
To address these competing needs, several policies have been implemented across the U.S. California’s Bill 394, for example, mandates staffing ratios, ensuring a baseline for the number of nurses needed per patient (Tevington, 2011). Other states have also introduced similar bills, aiming to regulate nurse staffing ratios (Davidson, 2022). However, laws around mandatory staffing ratios have been critiqued for not accounting for variables like nurses’ experience, education, or patient acuity, and there is still a lack of research validating the effectiveness of these mandates (Tevington, 2011). Despite this, studies have shown that increased RN staffing ratios correlate with improved patient outcomes, quality of care, and staff retention (Tevington, 2011).
The Registered Nurse Safe Staffing Act of 2015 takes this further by requiring hospitals to ensure safe staffing levels and establish committees that include nurses in the decision-making process regarding staffing needs (Congress, 2016). These committees provide a platform for nurses to advocate for quality care and ethical care delivery, reflecting Provision Six and Provision Seven of the ANA Code of Ethics. By incorporating nurses’ input into staffing decisions, this policy aligns with the ethical duty to ensure that patients receive safe, effective care and that nurses work in environments that support their well-being.
For those interested in learning more about these policies and their implications, nursing research, nursing assignments, and custom nursing papers can offer deeper insights into the challenges of balancing nursing staffing, financial constraints, and the delivery of ethical care. Accessing online nursing essays and top nursing papers can also help further understand how these competing needs shape nursing policy and patient care outcomes.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Congress. (2016). Summary: S. 1132-114th Congress (2015-2016). https://www.congress.gov/bill/114th-congress/senate-Links to an external site. bill/1132#:~:text=Requires%20the%20plan%20to%20require,of%20safe%2C%20quality%20patient%20careLinks to an external site.
Davidson, Alexa. (2022). Nurse-to-staffing ratio laws and regulation by state. https://nursejournal.org/articles/nurse-to-patient-staffing-ratio-laws-by-state/Links to an external site.
Haddad LM, Annamaraju P, Toney-Butler TJ. (2022). Nursing Shortage. Stat Pearls. https://www.ncbi.nlm.nih.gov/books/NBK493175/
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.htmlLinks to an external site.
Parsons, J. E., F.A.C.H.E. (2019). Addressing Workforce Challenges in Healthcare Calls for Proactive Leadership. Frontiers of Health Services Management, 35(4), 11-17. https://doi.org/10.1097/HAP.0000000000000058
Tevington, P. (2011). Professional Issues. Mandatory Nurse-Patient Ratios. MEDSURG Nursing, 20(5), 265–268.
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Collapse SubdiscussionIris Cornell Beth, a response from the instructor
Beth thanks for sharing a good posting. Does your work allow nurses t become involved with policymaking? If so, how?
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Collapse SubdiscussionBeth Howell Discussion Module 2 /Week 3, Response 1 – Beth Howell
Hello Dr. Cornell,
Thank you for your response.
My workplace does not have a formal policy for involving nurses in policymaking, but it demonstrates a clear commitment to valuing nursing input. The organization was originally founded by two nurse practitioners over 20 years ago and continues to maintain a nurse-centric model. Even after being acquired by a large corporation in 2020, the company has preserved this nurse-centered approach, with three of the five leadership positions held by nurses.
The transition to the larger corporation, which is more focused on numbers and financial metrics, has had its challenges. However, our leadership has been exceptional in listening to nurses’ concerns, particularly during the acquisition, the COVID-19 pandemic, IT challenges, and overwhelming schedules at times. They have exemplified what Broome & Marshall (2021) describe as “chief listening skills,” demonstrating a genuine effort to engage with nurses throughout these changes. Despite these challenges, nurses have continued to deliver quality, patient-centered care.
One significant change that occurred after the acquisition was the switch from using Body Mass Index (BMI) to waist circumference ratios in line with new research on biometric health predictors (Das et al., 2016). The company actively sought nurse input on this decision and addressed the ethical concerns raised regarding the change. This emphasis on involving nurses in decision-making is a key factor in retaining nurses and enhancing job satisfaction, as noted by the National Academy of Sciences, Engineering, and Medicine (NASEM, 2022).
In conclusion, while there is no formalized policy for nurse involvement in policymaking at my organization, the company values nursing input and actively seeks it when forming and implementing policies. This collaborative approach helps ensure that policies are not only aligned with the latest research but also consider the ethical and practical perspectives of the nursing staff.
For those exploring how nursing input can influence policy development and patient care, reviewing nursing papers, nursing research, and nursing assignments can offer valuable insights into how nurses’ perspectives shape effective healthcare policies and improve patient outcomes.
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Das, S., Minz, N., & Sahu, M. C. (2016). The relationship of abdominal girth with blood pressure, blood sugar and lipid profile among cardiac patients. Journal of Taibah University Medical Sciences, 12(2), 178–182. https://doi.org/10.1016/j.jtumed.2016.10.007Links to an external site.
National Academies of Science, Engineering& Medicine (2022). Servant Leadership’ Retains Healthcare Staff. Hospital Employee Health, 41(7)
https://www.proquest.com/trade-journals/servant-leadership-retains-healthcare-staff/docview/2674676164/se-2?accountid=14872
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Collapse SubdiscussionJan Griffin Response 1 to Beth:
I thoroughly enjoyed your post regarding nursing shortages and how ethics must be followed when caring for patients. Money is one of the most immense competing needs when dealing with this issue and will probably be for years to come. A significant expense is being spent on travel nurses, overtime, and bonuses to obtain enough staff. According to Son et al. (2019), nurses were asked to stay after their 12-hour shift for mandatory overtime due to short staffing, which can increase the chance of burnout and health concerns. For many shifts in the intensive care unit, I could only scarf down a kid’s snack and get back to the floor as soon as possible because there was too much work for one person. This took place close to 10 years ago, and yes, we had a shortage of nurses but nothing like we are dealing with today. Our breaks were cut short due to the level of care the patient needed or the family having questions. Laustsen and Brahe (2018) spoke about how nurses’ interruptions can affect patient safety, time management issues, and camaraderie within the department. Labor councils have and will hopefully continue to support the healthcare workers and work to protect the staff involved by presenting this and other issues to congress.
References:
Laustsen, S., & Brahe, L. (2018). Coping with interruptions in clinical nursing—A qualitative study. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 27(7–8), 1497–1506. https://doi.org/10.1111/jocn.14288Links to an external site.
Son, Y.-J., Lee, E. K., & Ko, Y. (2019). Association of Working Hours and Patient Safety Competencies with Adverse Nurse Outcomes: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 16(21). https://doi.org/10.3390/ijerph16214083Links to an external site.
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Collapse SubdiscussionJared Munoz Beth,
I agree with you that nursing shortages are an issue in healthcare. It is our duty as nurses to establish, maintain, and improve the work environment to ensure that patient is safe and receives quality of care (ANA, 2015). It is hard to accomplish that when hospitals are short nurses and with an increase in patient admissions. When “healthcare organizations shift from a treat-heal-care model to a more corporate or business paradigm, with emphasis on efficiency and cost outcomes as opposed to patient outcomes” (Grinspun, 2000) puts more stress on nurses due to increased nurse/patient ratios because with this model it’s about the money instead of the care. I like how you brought up the bill in California that is a mandatory nurse/patient ratio, and it will not go beyond that. This provides a situation where nurses can focus on the patients, they have without worry that more patients will be under their care. Depending on the acuity it is stressful enough with a few high acuity patients.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements Links to an external site. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Grinspun, D. (2000). Taking care of the bottom line: Shifting paradigms in hospital management. In D. Gustafson (Eds.), Care and consequences: The impact of health care reform (pp. 25-48) Halifax, NS: Fernwood Publishing.
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Collapse SubdiscussionAbie Kamara Great post Beth!
The shortage of nurses has contributed to the development of policies, affecting the demand for nursing services and the supply of nurses. Some factors impacting the recruitment and retention of nurses include the current environment and the lack of interest in the profession among students.
The increasing number of nurses entering retirement age and the lack of compensation are some of the factors that are contributing to the current shortage of nurses. Although the demand for nursing services will continue to increase, the profession must be involved in developing policies that will address the issue.References
Hamilton, G. (2011). The nurses are innocent (2nd ed.). Dundurn.
Lovan, S. R. (2011). Comparing perceptions of the nursing profession among associate and baccalaureate nursing students and registered nurses.
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Collapse SubdiscussionHannah Timmer Response 2,
Hi Beth,
I really enjoyed reading your post, especially the part about the California Bill regarding nurse staffing ratios. It inspired me to research similar information in Illinois. I found that the Safe Patient Limits Act, which is currently being considered by the Illinois Legislature, proposes a minimum staffing requirement of no more than four patients per nurse (American Nurses Association, 2021). I found this particularly refreshing because, on my shifts, I often have to care for 6-7 patients. The nursing shortage is a pressing issue that definitely needs more public and national attention. Without this, we will continue facing the same challenges in the healthcare system.
As nurses, it’s crucial for us to speak up and advocate for changes in our work environment. Kelly & Poor (2018) emphasize how important it is for RNs to expose the realities of their working conditions in order to improve patient care and nurse well-being. I couldn’t agree more with this statement. By highlighting the true impact of the nursing shortage, we can push for more meaningful solutions.
I often hear people say that my job is “easy” because I only work three days a week, but they have no idea what those 12-14 hour shifts are like. People don’t fully understand the burnout, mental and emotional strain, and critical thinking required to care for multiple patients at once. I am responsible for the lives of 6-7 patients simultaneously, and the work it takes is immense. Many people are simply unaware of what we go through, and the only way we will see change is if we speak out and educate others. Just as we advocate for our patients, we must also advocate for ourselves.
A great way to get involved and advocate for change is by becoming a member of a nursing organization. I am a member of the AANP, which provides access to nursing journals, networking opportunities, and clinical resources. It’s a fantastic platform for support and staying up-to-date with the latest nursing research and healthcare policies. Being part of this organization has been incredibly beneficial for my professional development and has empowered me to feel like I truly have a voice. I always encourage my colleagues to join too, as it’s a great tool for growth and advocacy.
For anyone looking to better understand these issues or find ways to get involved, nursing papers, nursing essays, and nursing research are great resources for learning more about how we can improve nurse staffing, patient care, and overall nurse satisfaction. Through collective action and continuous education, we can help create the change we need to better support nurses and improve the healthcare system as a whole.
References
American Nurses Association . (2021). The Nurse Staffing Improvement Act of 2021. ANA Illinois. Retrieved from https://www.ana-illinois.org/the-nurse-staffing-improvement-act-of-2021/
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06 http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodi cals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost- Containment.html Links to an external site.Links to an external site.
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Collapse SubdiscussionTammy Young Beth,
I truly appreciated your insight into the nursing shortage and the policies that are beginning to address this pressing issue.
As nurses, we are trained to deliver care with ethical responsibility and a strong focus on patient care goals, aiming to provide the best possible outcomes (Milliken, 2018). However, the nursing shortage has become a significant barrier to this goal. In 2020, the nursing shortage was estimated to be nearly one million nurses in the U.S. alone. With the increasing demands placed on nurses, providing quality healthcare has become more challenging, and the shortage is now one of the main factors driving global health policy (Marc et al., 2019).
This shortage directly impacts how healthcare policies are written and adopted (Aiken & Cheung, 2008). To create and implement effective policies that will help address the nursing shortage, it requires a collaborative effort from various stakeholders, including political leaders, healthcare institutions, and health insurance providers, among others. Moreover, it is crucial that nurses have a seat at the policy-making table. Nurses need to be actively involved in crafting policies that will reduce the nursing shortage while enhancing both the practice and education environments. Key aspects of these policies should include effective workforce planning, better utilization of nursing resources, improved recruitment, expanded education opportunities, and increased flexibility in work schedules (Marc et al., 2019).
It is also essential for policies to identify factors that encourage the retention of nurses. One important factor in nurse job satisfaction is the ability to make a real difference in a patient’s life. However, the growing emphasis on the business model of healthcare is often in conflict with the ethical care principles nurses are taught during their training. Nurses are acutely aware when they are unable to deliver the level of care they know is needed, and this disconnect can lead to dissatisfaction and burnout. Additionally, nurses possess invaluable front-line knowledge that should be actively sought and heard. Giving nurses autonomy and recognizing their capacity to contribute to decision-making is critical in improving job satisfaction and fostering an environment where ethical care can thrive. Acknowledging the voice of RNs is vital to creating positive work settings that prioritize both nurse well-being and patient safety (Kelly & Porr, 2018).
For those interested in the intersection of nursing practice and policy, nursing research, nursing papers, and nursing assignments can offer deeper insights into how policy changes can address the nursing shortage and improve overall healthcare delivery. Nurses must continue to advocate for their role in policymaking and work to ensure that nursing voices are heard in the development of healthcare policies that impact both their working conditions and the quality of care they can provide.
References
Aiken, L. and R. Cheung. (2008). “Nurse Workforce Challenges in the United States: Implications for Policy”, OECD Health Working Papers, No. 35, OECD Publishing. https://doi.org/10.1787/236153608331Links to an external site..
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice Links to an external site.Links to an external site.. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
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_A_nursing_shortage_-_a_prospect_of_global_and_local_policies/links/5b7440dca6fdcc87df7fc0ac/A-nursing-shortage-a-prospect-of-global-and-local-policies.pdfLinks to an external site.
Milliken, A. (2018). Ethical awareness: What is it and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.htmlLinks to an external site.
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Collapse SubdiscussionPaulphielle Mcqueen Response #1 to Beth Howell
I agree with you that nursing shortages is one of the major issues nationwide in the healthcare field. Nursing shortages should be addressed head on for the safety of nurses and patients and to reduce the number of nurse turnovers. Some of the ways hospitals have implemented trying to fully staff every shift is by allocating a “bonus” which is an additional amount of money on top of your hourly wage (Morris, 2022). Also, at my hospital a lot of my colleagues are cross trained to be able to work on different units as well, to better aid the healthcare facility. With the nursing shortage for patient safety these are good initiatives to start to be able to fully staff any facility. To be able to reduce the nurse turnover and decrease the shortages of nurses it is important to try and have more nurse educators to be able to produce more nurses in the healthcare field (Haddad et al,. 2022).
Reference
Haddad LM, Annamaraju P, Toney-Butler TJ. Nursing Shortage. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK493175/Links to an external site.
Morris, G. (2022, October 6). Nursing shortage solutions: 28 initiatives by states, schools, and Hospitals. NurseJournal. Retrieved December 15, 2022, from https://nursejournal.org/articles/nursing-shortage-solutions/
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Collapse SubdiscussionElin Danelian Week 3 Discussion- Response 2
Hello Beth,
Great post! I completely agree with your insights, especially the need for resources to address competing needs in nursing and sustain the implementation of policies that support both the workforce and nursing education. Nurses are often under intense pressure to complete tasks quickly and efficiently, which can lead to burnout and even ethical insensitivity (Mudallal et al., 2017). This is why I agree with your point about the importance of nurses advocating, especially when it comes to policy-making. As the largest group of healthcare workers, nurses play a vital role in improving health systems and ensuring the quality of patient care (Hajizadeh et al., 2021).
In the department where I work, leadership once set an unrealistic expectation for us to discharge patients within an hour of receiving the order. This policy created a great deal of stress among nurses, as it was simply not feasible to ensure that safe discharge instructions were provided under such tight time constraints. This situation raised serious ethical concerns about whether we were compromising patient safety in favor of efficiency. Fortunately, our unit-based council came together and voiced these concerns to leadership. We made it clear that if nurses were unable to meet these demands, it could lead to ethical violations and unsafe care. Our collective advocacy led to the policy being retracted, and a more realistic and safe approach to patient discharge was implemented.
This experience shows the power of nurses working together to influence policy changes that directly impact the safety and well-being of both patients and staff. It also highlights how important it is for nurses to be involved in policymaking at every level of healthcare to ensure that ethical standards and patient care remain the top priorities.
I think this situation is a good example of how nurses’ voices can be instrumental in shaping healthcare policies that align with the realities of nursing practice, ultimately benefiting both the workforce and the patients we serve.
For those interested in how nurses can influence policy, nursing research, nursing papers, and nursing assignments can offer helpful resources on the intersection of nursing practice and policy development. The more we advocate and speak up for what’s right, the better we can create a healthcare system that works for everyone.
References
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R. & Khodayari, R. (2021). Factors influencing nurses participation in the health policy-making process: a systematic review. BMC Nursing, 20, 128. https://doi.org/10.1186/s12912-021-00648-6
Mudallal, R., Othman, W., & Hassan, N. (2017). Nurses’ Burnout: The Influence of Leader Empowering Behaviors, Work Conditions, and Demographic Traits, 26(1), 33-35. https://doi.org/10.1177/0046958017724944
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Collapse SubdiscussionMichele Cleary Module 2 Discussion 6053N
How Competing Needs Impact Policy Development
Healthcare is constantly evolving to meet the demands of patients, healthcare facilities, and the surrounding communities. As healthcare organizations strive to remain profitable while continuing to provide care, policies and procedures are regularly updated. However, these standardized policies, while often efficient and cost-effective, can sometimes interfere with nurses’ ability to provide ethical, individualized care (Kelly & Porr, 2018). Nurses are ethically bound to recognize the moral implications of their actions, resolve ethical dilemmas, and address patient needs in a way that aligns with their professional responsibilities (ANA, 2015). The balance between meeting business needs and ensuring ethical, patient-centered care is one of the key challenges nurses face in policy development.
Specific Competing Needs that Interfere with Nurse Burnout
Policies in healthcare are continually updated, sometimes on a daily, weekly, or monthly basis, to meet the ever-changing demands of the healthcare environment. However, when nurse staffing or ancillary support is inadequate, the responsibilities of nurses can increase, leading to burnout and ethical stress. For example, in my outpatient oncology center, when another department is short-staffed, it impacts the infusion nurses. If a call center operator calls out, the infusion nurses must take on the task of handling patient calls. If the lab is understaffed, the nurses may be responsible for drawing labs before chemotherapy treatments. If the infusion scheduler is absent, nurses often have to ensure patients are scheduled for follow-up appointments. Additionally, if a pharmacy technician is unavailable, infusion nurses may need to admix chemotherapy drugs themselves. In the absence of a physician, nurses may even be required to assess patients and adjust treatment as necessary. These additional duties are necessary to meet the operational needs of the office, but they add significant stress to an already demanding job. The increased workload raises the risk of nurse burnout, which can have serious consequences for both nurse well-being and patient care.
Nurses’ emotional intelligence plays a crucial role in managing this stress. Being self-aware and emotionally intelligent helps nurses maintain healthy relationships and cope with the pressure of their duties (Walden, 2009). Nurses must also acknowledge their ethical responsibility to themselves, as outlined by the American Nurses Association (ANA). Nurses are not only responsible for the health and safety of their patients, but they also have a duty to promote their own well-being, maintain competence, and pursue personal and professional growth (ANA, 2015). Ethical dilemmas arise when nurses are pushed to take on more than they can handle, which can jeopardize their health and the quality of care they provide. Nurses must be empowered to recognize when their workload becomes excessive and to speak up for their safety and the safety of their patients (Kelly & Porr, 2018).
How Policy Addresses These Competing Needs
Given the complexity of modern healthcare, it’s essential that nurses remain vigilant and aware of ethical issues as they arise. Strong leadership within healthcare organizations is vital to creating a healthy work environment that supports nurses in their ethical obligations. When leadership recognizes the already full roles of nurses and refrains from adding unnecessary tasks to their workload, it helps reduce ethical risks and burnout. Ethical awareness should be an ongoing part of nursing practice and decision-making (Milliken, 2018). While most people associate ethical awareness with doing what is right for the patient, the ANA Code of Ethics emphasizes that nurses also have an ethical commitment to their own health and safety (ANA, 2015). Nurses must protect their own well-being to be able to provide the highest level of care to their patients.
Conclusion
Nurses should never take unnecessary risks that compromise their health or safety. Burnout and compassion fatigue not only impact a nurse’s ability to care for patients but also pose a significant threat to the overall quality of care. Nurses need to be self-aware of their emotional intelligence and be willing to speak up for their ethical well-being. By fostering a work environment that values nurse health and safety, healthcare institutions can ensure that nurses are equipped to provide the best care possible to their patients. Policies must evolve to account for the emotional and physical demands placed on nurses and provide the necessary support to reduce burnout, ultimately leading to improved outcomes for both nurses and patients.
In the context of nursing research, nursing papers, and nursing assignments, exploring the intersection of policy development and nurse well-being can provide valuable insights for creating environments where both nurses and patients thrive.
References:
American Nurses Association. (2015). Code of ethics for nurses with interpretive
Statements. Silver Spring, MD: Author, Retrieved from
https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment:
Considerations to enhance RN practice. OJJN. Online Journal of Issues in
Nursing, 23(1), Manuscript 6. Doi:10.3912/ONJJ.Vol23No01Man06.
Retrieved from http://ojnn.nursingworld.org/ManMenuCategories/ANALinks to an external site.
Marketplace/ANAPeriodicals/OJNN/TableofContents/Vol-23-2018/No1-Jan2018/Ethical-Nursing-Cost-Containment.html
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN:Online
Journal of Issues in Nursing. 23(1). Manuscript 1.
Doi:10.3912/OJIN.Vol23.No01.Man01. Retrieved from http://ojnn.nursingworldLinks to an external site..
Org/MainMenuCategories?ANAMarketplace/ANAPeriodicals/OJNN/Tableof
Contents/vol-23-2018/No1-Jan2018/Ethical-Awareness.html
Walden University, LLC. (Producer). (2009). Working with Individuals. [Video file].
Baltimore, MD: Author.
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Collapse SubdiscussionIris Cornell Michele response from the instructor
Michele thanks for sharing. Ulrich et al. (2010) shared implications found from their study. Their key points made are relevant to what we are experiencing in nursing currently. These points were:
- “Addressing ethical issues nurses encounter in healthcare is key to the delivery of quality patient care and retention of qualified staff.
- More dialogue is needed on the role of ethics education in reducing ethics stress and helping staff to feel comfortable in discussing ethical issues.
- National and international strategies are needed to address ethical issues in clinical practice and their effect on nurse- and patient-related outcomes” (Ulrich et al., 2010, Summary Statement).
I do believe it is so needed to have strategies to reduce the ethical burnout we are experiencing, what do you think?
Reference
Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010). Everyday ethics: Ethical issues and stress in nursing practice. Journal of Advanced Nursing, 66(11), 2510–2519. https://doi.org/10.1111/j.1365-2648.2010.05425.x
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Collapse SubdiscussionMichele Cleary Response # 2, Module 2
Dr. Cornell,
As of February 2021, nearly 47% of nurses reported wanting to leave their jobs due to negative impacts on their health, a figure that rose to 60% during the pandemic (Sachdeva, 2022). This alarming statistic highlights the growing issue of nurse burnout, a crisis that has intensified in recent years. Nursing leadership must address this challenge by implementing strategies that prioritize nurse well-being and reduce burnout.
Several key actions can help alleviate burnout among nurses. First, optimizing workflow by ensuring nurses focus on their assigned tasks rather than taking on duties from ancillary departments is crucial. Additionally, improving nurse-to-patient ratios can make workloads more manageable and reduce stress. Open communication between nurse leaders and staff is essential to address concerns and create a supportive environment. Leaders should actively listen to nurses, recognize their contributions, and show appreciation for their hard work. Offering flexible scheduling can also help, as long as shifts are adequately covered, allowing nurses to balance work and personal commitments. Furthermore, well-being initiatives, such as wellness programs, gym membership discounts, and fitness challenges, have proven effective in promoting a healthy work-life balance (Sachdeva, 2022). For instance, my office has partnered with Power of Vitality, offering incentives like reduced insurance premiums and gift cards for participation in wellness activities, which have been positively received by staff.
Another effective strategy to combat burnout is focusing on training and mentorship programs. Research shows that preceptorships and clinical supervision play a significant role in improving nurse retention and easing the transition from student to practicing nurse (Dulko & Kohal, 2022). Preceptors, who are experienced nurses, guide new nurses through their orientation and clinical practice, helping them adjust to the demands of the job. Studies have shown that residency programs and structured mentorship can result in retention rates as high as 90% in the first year of practice (Dulko & Kohal, 2022). Organizations that provide new graduate programs can better support nurses during this critical transition, easing the shift from education to professional practice and helping them build the confidence needed to thrive in their roles.
Ultimately, supporting nurse education, fostering open communication, and implementing strategies to reduce nurse burnout will lead to a more effective, satisfied, and sustainable nursing workforce. When nurses are supported and their well-being is prioritized, healthcare organizations experience less turnover, greater nurse satisfaction, and improved patient care outcomes. The benefits of investing in nurse well-being are clear, and leadership must make these initiatives a priority to create a healthier work environment for nurses and better outcomes for patients.
Thank you for your time and consideration.
References:
Dulko, D., Kohal, B. (2022). How do we reduce burnout in nursing? Nursing Clinics of North America. Volume 57, Issue 1, Pages 101-
104. https:// doi:org/10.1016/j.cnur.2021.11.007
Sachdeva, Akshay. (2022). Workplace culture: 6 things leaders can do to prevent nurse burnout. Workforce.com
Retrived from : https://worforce.com/news/6-things-leadership-can-do-to-prevent-nurse-burnout.
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Collapse SubdiscussionKatie Saletel Response #1
Thank you for your insightful post, Michele.
I completely agree with your observations regarding the ongoing nurse shortage and burnout crisis. It is remarkable that the shortage has been predicted and recognized for over a decade, yet many healthcare organizations still seem reactive rather than proactive when it comes to recruiting and retaining nurses. One notable exception is the American Nurses Credentialing Center (ANCC), which, through the American Nurses Association (ANA), introduced the Magnet Recognition Program. This program allows hospitals to showcase their commitment to nursing excellence and create environments that prioritize nurse satisfaction and retention (Kelly et al., 2019).
Magnet hospitals are often regarded as models for best practices in nursing care. They tend to have higher nursing qualifications, lower mortality rates, fewer infections, and decreased staff turnover. While research studies may vary on whether Magnet hospitals have superior staffing models compared to non-Magnet hospitals, the evidence consistently shows that Magnet designation is associated with higher job satisfaction and lower turnover rates among nurses (Pedrosa et al., 2021). In the context of the current nursing shortage, Magnet hospitals serve as vital examples of how organizations can create environments that support nursing staff and improve both staff well-being and patient outcomes.
I also appreciate your mention of the importance of nursing involvement in policy, education, mentorship, and leadership. Magnet hospitals focus on servant leadership, where leaders are expected to serve their teams, listening to concerns and fostering a supportive work environment. This leadership style is crucial in addressing burnout, as it promotes nurse empowerment and professional growth, which directly contribute to nurse retention and job satisfaction (Rodríguez-García, 2020).
Given the current nursing shortage, creating policies that integrate nursing input in decision-making processes is essential. Including nurses in policy development not only improves job satisfaction but also enhances the quality of patient care. Hospitals and healthcare organizations should consider adopting Magnet-like practices to help alleviate burnout, reduce turnover, and improve patient outcomes during this critical time.
References
Brady-Schwartz, D., (2005). Further Evidence on the Magnet Recognition Program: Implications for Nursing Leaders. JONA: The Journal of Nursing Administration, 35(9):p 397-403. https://journals.lww.com/jonajournal/Abstract/2005/09000/Further_Evidence_on_the_Magnet_Recognition.9.aspxLinks to an external site.
Kelly, L., McHugh, M., Aiken, L., (2019). Nurse Outcomes in Magnet® and Non-Magnet Hospitals. JONA: The Journal of Nursing Administration, October 2019, 49 (10S), S19-S24. https://doi.org/10.1097/NNA.0000000000000801
Pedrosa, J., Sousa, L., Valentim, O., & Antunes, V. (2021). Organizational culture and nurse’s turnover: A systematic literature review. International Journal of Healthcare Management, 14(4), 1542–1550. https://doi.org/10.1080/20479700.2020.1801160Links to an external site.
Rodríguez-García, M. , Márquez-Hernández, V. , Belmonte-García, T. , Gutiérrez-Puertas, L. & Granados-Gámez, G. (2020). Original Research: How Magnet Hospital Status Affects Nurses, Patients, and Organizations: A Systematic Review. AJN, American Journal of Nursing, 120 (7), 28-38. https://doi.org/10.1097/01.NAJ.0000681648.48249.16
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Collapse SubdiscussionDaniel Russell Wright Dr. Cornell,
Thank you for your insightful post on the importance of ethical leadership in nursing. I completely agree with you that, despite the unprecedented changes occurring in healthcare, nurses remain one of the most trusted and ethical professions. This trust is foundational in patient care, and nursing leadership plays a pivotal role in maintaining this standard of ethical practice.
You’ve highlighted an essential point regarding ethical leadership: it is not just about providing guidance but also fostering an environment that encourages moral awareness and enables nurses to act as moral agents in their day-to-day practice. Ethical leadership is essential in creating a work culture where nurses feel empowered to speak up about ethical concerns, engage in difficult conversations, and ultimately provide the best possible care for patients (Barkhordari-Sharifabad, 2017). This type of leadership not only helps to mitigate moral distress but also reduces burnout and supports overall job satisfaction.
I particularly appreciate your mention of the American Nurses Association’s (ANA) Code of Ethics and its framework for ethical practice. The structure you outlined (Provisions 1-3, 4-6, and 7-9) serves as a comprehensive guide to ethical decision-making, providing nurses with the foundation needed to navigate the complexities of patient care (Maryville University, 2022). As you rightly pointed out, moral awareness is vital—nurses must be constantly aware of how their actions align with the core principles of nonmaleficence, beneficence, autonomy, and justice. The ability to evaluate ethical dilemmas through this lens allows nurses to ensure that their actions are aligned with both professional standards and patient values.
Another important aspect you mentioned is the challenge that many nurses face: feeling unprepared to handle ethical dilemmas. This lack of preparedness can indeed lead to moral distress and even burnout, which can compromise the care provided to patients. The research you referenced (Milliken, 2018) underscores the significance of increased ethical awareness and the necessity for nurses to have the tools and resources they need to address these challenges effectively.
One effective strategy is the development of moral leadership within healthcare organizations. As you pointed out, this type of leadership can greatly reduce moral distress, enhance job satisfaction, and promote an ethical work environment (Barkhordari-Sharifabad, 2017). When leaders model ethical behaviors, encourage open dialogue, and provide nurses with a platform to express concerns, it creates a culture of trust and collaboration. This environment allows nurses to feel heard and valued, which not only boosts their psychological empowerment but also directly impacts patient care quality.
Lastly, I completely agree that ethical leadership is essential in mitigating the negative repercussions of unethical behavior in the workplace. When nurses are empowered to advocate for their patients, make ethical decisions, and address concerns without fear of retaliation, they are more likely to remain engaged, committed, and motivated in their roles. This, in turn, reduces burnout and improves overall job satisfaction.
Thank you again for your post, and for emphasizing the importance of ethical leadership in nursing practice. It’s clear that creating an environment that nurtures both the ethical well-being of nurses and the moral integrity of care is essential to fostering both nurse satisfaction and the highest standards of patient care.
References
Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, F. (2017). Obstacles and problems of ethical leadership from the perspective of nursing leaders: a qualitative content analysis. Journal of medical ethics and history of medicine, 10, 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432950/Links to an external site.
Maryville University. (2022). Nursing Ethics: Ethical Decision-Making for Nurse Leaders. Maryville University. https://online.maryville.edu/blog/nursing-ethics/Links to an external site.
Milliken, A. (2018, January 31). Ethical Awareness: What It Is and Why It Matters . The Online Journal of Issues in Nursing. https://ojin.nursingworld.org/table-of-contents/volume-23-2018/number-1-january-2018/ethical-awareness/Links to an external site.
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Thank you for your thoughtful post, Daniel.
I completely agree with your point about grounded leadership and its importance in upholding ethics and core values within the nursing profession. As Broome & Marshall (2021) emphasized, a foundation built on ethical principles and values has a significant impact on nursing practice and can guide staff in making sound decisions that ensure quality care. Leadership that demonstrates a commitment to these values helps nurses stay true to their ethical responsibilities, which ultimately benefits patients and the healthcare system as a whole.
I also appreciate your mention of the American Nurses Association (ANA) and the updates to the Code of Ethics, particularly Provision 3 and Interpretive Statement 3.4 (Olson & Stokes, 2016). This addition underscores the nurses’ duty to promote a safe work culture and ensure that patient care is delivered safely and effectively. One critical way to uphold this duty is through the adoption of a Just Culture model within leadership.
The Just Culture approach, as you correctly pointed out, emphasizes a non-punitive response to errors while focusing on learning and improvement. This is vital in nursing, where mistakes, especially medication administration errors, can have serious consequences. However, as you mentioned, not all errors result in harm, and fostering an environment where nurses feel safe to report mistakes without fear of retribution is key to identifying system weaknesses and making improvements. The role of leadership here is paramount, not just in ensuring that errors are reported but also in offering the education and resources needed to prevent future mistakes and support continuous improvement (Kelly & Porr, 2018). Nurses must feel empowered to speak up when they observe unsafe practices, both their own and those of others, and leadership must support this process to enhance the overall safety culture.
In addition to fostering an environment of safety and learning, effective leadership should also prioritize ongoing nurse education and research. As you mentioned, knowledgeable nurses are more confident in their decision-making and can uphold ethical standards more effectively. By providing continuous educational opportunities and ensuring that nursing practices are grounded in evidence-based research, leadership can empower nurses to provide the highest quality of care, in line with the ethical principles that guide the profession (Kelly & Porr, 2018). This investment in education and research not only improves patient outcomes but also enhances nurse satisfaction and retention.
Your insights clearly illustrate the critical relationship between ethics, leadership, and patient care. By fostering an ethical, supportive, and knowledgeable work environment, both leadership and nurses can collaborate effectively to ensure that safe, high-quality patient care is consistently delivered.
Thank you again for sharing your valuable perspectives on this important topic.
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References
Broome, M., Sorensen Marshall, E., (2021). Transformational Leadership in Nursing (3rd Ed.), Pg. 8. Springer Publishing Company
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. https://doi.org/10.3912/OJIN.Vol23No01Man06Links to an external site.
Olson, L. L., & Stokes, F. (2016). The ANA Code of Ethics for Nurses With Interpretive Statements: Resource for Nursing Regulation. Journal of Nursing Regulation, 7(2), 9–20. https://doi.org/10.1016/S2155-8256(16)31073-0Links to an external site.
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Hello Michele,
Thank you for your post and your commitment to providing care amidst an environment with many demands. Providing care, especially the kind of care that uses so many psychological and emotional skills, is challenging. Your environment clearly illustrates the ethical need and commitment for nurses to care for themselves as stated in the code of ethics provision five (ANA, 2015).
The environment we work in plays a significant role in retention and happiness, especially in oncology settings (Paiva et al., 2021). I am curious if the outpatient clinic offsets the challenges with team building and affirming activities as a strategy to reduce burnout (Paiva et al., 2021). Paiva et al. Research suggests that measures should be implemented at the institutional level to offset burnout (Paiva et al., 2021).
Balancing the needs of patients, nurses, and support staff while keeping an eye on cost-effectiveness is a delicate act. Nurses can articulate these challenges and improve their working conditions and help guide workplace policies regarding burnout (Kelly & Poor, 2018).
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.htmlLinks to an external site.
Paiva, B, Mingardi, M., Valentino, T., de Oliveira, M., & Paiva, C. (2021). Prevalence of burnout and predictive factors among oncology nursing professionals: a cross-sectional study. São Paulo Medical Journal, 139(4), 341–350.https://doi.org/10.1590/1516-3180.2020.0606.R1.1202021Links to an external site.
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Collapse SubdiscussionMichele Cleary Hi Beth,
Thank you for your response. Currently, we do not have any team-building type activities. We are good about supporting each other and talking about difficult situations as they arise. Many of us have been working together for ten or more years, so we are friends and spend time together outside work. We must recognize when our hearts are heavy, and we need a few minutes to decompress. I am working on in-house interventions to assist some of the newer nurses in helping decrease burnout.
Thanks so much,
Michele
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Collapse SubdiscussionAbie Kamara Great post, Michele!
I completely agree with your points on the evolving nature of healthcare, especially the importance of addressing the needs of vulnerable communities. As you mentioned, for many people, particularly in urban and rural areas, the local hospital is often the only source of care. Unfortunately, as the healthcare system continues to transform, some of these communities risk losing access to essential services. This makes it even more critical to prioritize comprehensive strategies that ensure these individuals are not left behind as healthcare delivery and payment systems evolve.
I appreciated your discussion of the strategies identified by the task force to improve healthcare delivery. One key point is the need to establish systems that allow hospitals to provide essential services to vulnerable populations. This might include expanding access to preventative care, mental health services, and chronic disease management, all of which are often lacking in underserved areas. When healthcare systems adapt to meet the needs of vulnerable individuals, they help mitigate the risks associated with gaps in care, ensuring that people can make informed decisions about their health.
Your mention of the American Hospital Association’s (AHA) Path Forward is also spot on. Their commitment to improving healthcare delivery through new models of care and collaboration with other healthcare organizations is vital. As we move further into an era focused on value-based care, it’s clear that a shift away from volume-based care is necessary, especially as chronic conditions continue to rise. The fact that one in four Americans has multiple chronic conditions underscores the importance of coordinated care and improving health literacy to help people take ownership of their health. The AHA’s commitment to connecting with individuals in a way that makes sense in the digital age also reflects a growing trend toward virtual care, which can help make healthcare more accessible to everyone, especially in remote areas.
By focusing on quality, access, and affordability, the AHA is ensuring that all individuals—regardless of their socioeconomic status—have the opportunity to receive the care they need. This approach aligns with the broader goal of improving health equity and reducing disparities across different populations. As healthcare delivery continues to evolve, it is essential that performance improvements and quality care remain the foundation of healthcare systems, regardless of external changes or challenges.
Your post raises important questions about how the healthcare system can adapt to meet the needs of all populations, particularly those who are most vulnerable. As we move forward, creating innovative, patient-centered solutions will be essential in reducing healthcare disparities and improving overall patient outcomes.
Thanks again for your thoughtful contribution to this conversation!
References
American hospital association guide to the health care field. (n.d.).
Improving access to care in rural and underserved communities. (n.d.).
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Collapse SubdiscussionMichele Cleary Great points, Abie. Thank you for your reply.
Michele
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Collapse SubdiscussionOluwashola Adebola Adeniji Response #2 to Michele
Hello Michele,
In addition to working conditions and environment, organizational factors such as the supply of human resources, care facilities, and effective management approaches to psychiatric wards also play a decisive role in accelerating the process of burnout in nurses. Any ignorance or weakness of these organizational factors can be a contributing factor in the burnout of nurses. The failure of the organization to pay attention to supplying adequate and specialist human resources in psychiatric wards has resulted in an increased workload, limited time for continuously interacting with patients, mental exhaustion, and job dissatisfaction among nurses. As a direct result of the increased workload, there have also been more patients who have tried to kill themselves. All of these problems make it hard to reach health goals and provide timely, high-quality health services.
ReferencesWang S, Liu Y, Wang L. Nurse burnout: Personal and environmental factors as predictors. Int J Nurs Pract. 2015;21:78–86.
Pekurinen VM, Välimäki M, Virtanen M, Salo P, Kivimäki M, Vahtera J. Organizational justice and collaboration among nurses as correlates of violent assaults by patients in psychiatric care. Psychiatr Serv. 2017;68:490–6.
Rashedi V, Foroughan M, Hosseini MA. Correlation between organizational culture and burnout in the staff of Tehran province welfare organization. J Health Promot Manag. 2012;1:15–22.
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Balancing Ethics and Laws in Nursing Practice
You’ve raised an excellent point about the distinction between ethics and laws in nursing practice. While both play crucial roles in shaping healthcare delivery, they are not interchangeable. Ethics focuses on what is morally right, guiding nurses through complex decisions based on values like autonomy, beneficence, nonmaleficence, and justice. Laws, on the other hand, are formal rules that govern actions and ensure accountability. In nursing, ethical dilemmas often arise when these two frameworks overlap or conflict, especially when dealing with vulnerable patients or resource-limited environments. The key is always focusing on what is in the best interest of the patient, ensuring that both ethical principles and legal standards are upheld (Laureate Education, 2012).
The Nursing Shortage and Its Impact on Patient Care
The nursing shortage is indeed a significant and growing issue, and its implications for patient care cannot be understated. As you mentioned, when nurses are overburdened with too many patients, their ability to deliver high-quality care diminishes. This not only leads to nurse burnout and job dissatisfaction but also compromises patient safety and satisfaction. Research has shown that when nurses have excessive workloads, the likelihood of errors increases, including medication mistakes, failure to detect complications, and delayed responses to patient needs (Yang et al., 2015).
The quality of care and patient safety should always be top priorities, and these are often at risk in understaffed healthcare environments. This is where the creation of effective, evidence-based policies becomes essential. By addressing the underlying causes of nursing shortages—such as burnout, lack of support, and inadequate staffing ratios—leaders can make significant strides toward improving care and retaining staff.
Strategies for Improving Nurse Retention
As you pointed out, nurse retention can be improved by finding a balance between nurse workload and patient acuity. One effective way to manage this is by implementing acuity tools that assess patient needs and assist in determining safe nurse-patient ratios. This ensures that nurses are not overburdened with more patients than they can reasonably care for, especially in high-acuity areas like critical care. Acuity tools provide a framework for staffing decisions, allowing nurse managers to allocate resources effectively, improve nurse satisfaction, and reduce the risk of burnout (Ingram & Powell, 2018).
Leadership is also key in creating an environment where nurses feel supported and heard. Leaders should be proactive in addressing staffing shortages, listening to nurse concerns, and promoting strategies for well-being, such as flexible schedules, wellness programs, and opportunities for professional development. As you mentioned, unit managers and charge nurses play a critical role in balancing workloads and promoting a culture of safety and respect.
Policies Addressing the Nursing Shortage
You also touched on important policies from organizations like the American Nurses Association (ANA), which work to advocate for safer working conditions and ensure that nurses have the resources they need to provide safe care. In addition to staffing laws, the ANA has established standards for safe nursing practice and continues to advocate for policies that protect nurses from unsafe work environments.
In many states, nurse staffing laws are being implemented to ensure that healthcare facilities are adhering to appropriate staffing levels based on patient needs. When combined with patient acuity tools, these policies help to create a safer and more sustainable work environment for nurses, leading to better patient care outcomes.
It’s crucial that we continue to support the advocacy work of organizations like the ANA and others that push for changes in legislation to reduce the impact of nursing shortages. These efforts help to create an infrastructure that prioritizes nurse safety, patient care, and quality of life for both patients and healthcare professionals.
Conclusion
As we continue to address the challenges of nursing shortages, creating effective policies that support nurse well-being and patient safety is essential. Balancing ethical principles with legal guidelines can help ensure that nurses are empowered to make the right decisions in practice, while also being supported through policies that prevent burnout and improve retention. As you mentioned, ensuring safe nurse-patient ratios and promoting a positive work environment are vital steps toward reducing the nursing shortage and improving the overall quality of care provided to patients.
Thank you for sharing your insights on this critical issue. Your focus on the relationship between ethics, laws, and workplace policies is a timely reminder of the need for continued advocacy and thoughtful leadership in healthcare.
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References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Ingram, A., BSN, RN-BC, & Powell, J., BSN, RN. (2018, April 18). Patient acuity tool on a medical-surgical unit. https://www.americannursetoday.com/patient-acuity.com
Laureate Education (Producer). (2012). Ethical, Moral, and Legal Leadership [Video file]. Baltimore, MD: Author.
Yang, P., Hung, C., & Chen, Y. (2015). The impact of three nursing staffing models on nursing outcomes. Journal of Advanced Nursing (John Wiley & Sons, inc.), 71(8), 1847–1856.
https://doi-Links to an external site.org.ezp.waldenulibrary.org/10.1111/jan.12643
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Collapse SubdiscussionIris Cornell Paulphielle response from the instructor
Paulphielle thanks for sharing. thanks for sharing. What are the strengths of promoting ethics in policy decision-making?
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Collapse SubdiscussionKasondra Lewis Module 2 Discussion: Peer Response #1
Hello Paulphielle,
I really enjoyed your discussion. Like you, I mentioned nurse-to-patient ratios in my discussion this week, specifically the inclusion of acuity when determining ratios. According to Saaiman et al. (2021), nurse staffing ratios should be based on multiple factors, including acuity to improve working conditions, the quality of care, patient and staff satisfaction, and patient outcomes. While research proves that acuity-based nurse-to-patient ratios will improve the current state of healthcare, more research is needed to determine how acuity-based staffing can meet the financial needs of the organizations.
Your discussion also mentions staff burnout due to high volume and high acuity workloads. Currently, as nurses, we can work towards change regarding ratios. However, this change is likely to occur later. With that being said, we as nurses must act to help reduce burnout for ourselves and other nurses. In research from Green and Kinchen (2021), mindfulness meditation can be used to decrease burnout in nurses. This meditation technique has helped nurses to increase compassion and resiliency and regulate their emotions that have been negatively affected due to constant exposure to workloads, traumatic events, and human suffering (Green & Kinchen, 2021). To reduce staff burnout, organizations and nurses should make an effort to implement burnout reduction plans or programs.References
Green, A. A., & Kinchen, E. V. (2021). The Effects of Mindfulness Meditation on Stress and Burnout in Nurses. Journal of Holistic Nursing, 39(4), 356–368. https://doi.org/10.1177/08980101211015818
Saaiman, T., Filmalter, C. J., & Heyns, T. (2021). Important factors for planning nurse staffing in the emergency department: A consensus study. International Emergency Nursing, 56, 100979. https://doi.org/10.1016/j.ienj.2021.100979
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Collapse SubdiscussionMleh Porter Hello Paulphielle,
Thank you for a great post. The nursing staff shortage is a serious healthcare issue affecting patient safety and quality of care. With the decrease in the nursing, workforce comes more workload pilled on the already overburdened nurse. Unfortunately, nurses are expected to continue to provide quality care under these challenging circumstances leading to frustration and burnout (Kelly & Porr, 2018). The total number of registered nurses (RNs) in 2021 was 4.4 million. Only 3.2 million of these RNs were employed. Of the total number of employed RNS, only 1.8 million of them worked in hospitals, with many RNs citing staffing shortages and the failure of healthcare organizations to implement measures to improve the work environment for nurses as a reason to leave acute care setting (Nursing shortage or exodus, 2022).
In a recent survey, 62% of hospitals reported they had a 7.5% nurse vacancy rate. In another American Association of Critical Care Nurses (AACN) survey, two-thirds of critical care nurses have or are considering leaving their jobs (Hooper, 2022). Policies must be implemented to improve the nursing shortage. I agree that policies to improve the nurse-to-patient ratio based on acuity will improve the quality of care and safety for both patients and nurses. In addition, to combat the nursing shortage, health organizations must implement policies that increase nursing retention and augment the nursing workforce, such as nurse residency, externships, and mentorship programs. Nurse residency programs for new graduates have been shown to decrease turnover and increase retention among new nurses (Halter et al., 2017). I started my intensive care unit (ICU) journey as a nurse extern and eventually got hired as a new graduate nurse in the ICU in the same hospital I completed my externship. During my residency program, I received support from a nursing mentor, which helped me with my challenges as a new nurse and helped me stay in a very busy ICU. My hospital continues to participate in the nurse residency program, allowing more nurses into the workforce to help deal with the nursing shortage. Policies to improve nursing retention and augment the nursing workforce is vital to combat the nursing shortage.
References
Halter, M., Pelone, F., Boiko, O., Beighton, C., Harris, R., Gale, J., Gourlay, S., & Drennan, V. (2017). Interventions to Reduce Adult Nursing Turnover: A Systematic Review of Systematic Reviews. The open nursing journal, 11, 108–123. https://doi.org/10.2174/1874434601711010108
Hooper V. D. (2022). The future of nursing 2022: It is time for us to take the lead. Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses, 37(1), 1–2. https://doi.org/10.1016/j.jopan.2021.12.001
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN Practice. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man06
Nursing shortage or exodus? (2022). AJN, American Journal of Nursing, 122(3), 12–13. https://doi.org/10.1097/01.naj.0000822928.16774.9a
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Collapse SubdiscussionTammy Young Healthcare Policy
Almost every aspect of the healthcare delivery system has political and regulatory implications that are complicated to understand and navigate. It is most apparent that the organization of the political system drastically affects the quality of health care and the way it is delivered in the United States. Providing high-quality care is a goal that can unite the interests of all stakeholders, which entails defining and focusing on value as an important opportunity to spark and even facilitate improvement in all aspects of health care. In many cases, EBM is integrated with policy outcomes; however, the availability of resources has a notable impact on policy development (Institute of Medicine, 2008).
Healthcare policies are an essential part of the US healthcare system. These policies shape and protect the health and well-being of Americans. They include the legal and safety regulations by state or national protocols regarding how care and medicine are delivered.
Workforce and Resources Shape Policies
One concern that will shape healthcare policies is recovering from the Covid 19 crisis, which has devastated families and disrupted every aspect of our lives. Health insurance providers are working with national, state, and local leaders to encourage policies that allow Americans to access vaccines while continuing to overcome the crisis. In addition, socioeconomic conditions have a profound effect on people’s health. A common goal drives healthcare policies to ensure resources are available to everyone to pursue a healthier lifestyle. This includes adequate access to nutritious food, affordable housing, convenient and inefficient transportation options, opportunities for quality education, and meaningful employment ( Birk, 2016).
Upon evaluating the healthcare workforce, it is recognized that a shortage of close to a million professional nurses was estimated in 2020. An emerging physician shortage has further exacerbated this healthcare workforce shortage. This national shortage primarily affects how healthcare policies are written and adopted (Aiken& Cheung, 2008). It is essential that policymakers prioritize funding policies to expand and retain the healthcare workforce, so Americans to continue receiving the care they need (American Hospital Association, n.d.). One study showed that the active involvement of nurses in the policy-making process is essential to reduce nursing shortages and to enhance practice and educational environments (Abhicharttibutra, 2017). It is most important that healthcare policies are driven by values of the nursing profession in order for RNs to make a significant contribution to improving health (Kelly & Porr, 2018).
Abhicharttibutra, K., Kunaviktikul, W., Turale, S., Wichaikhum, O. A., & Srisuphan, W. (2017). Analysis of a government policy to address nursing shortage and nursing education quality. International nursing review, 64(1), 22–32. https://doi.org/10.1111/inr.12257Links to an external site.
American Hospital Association, (n.d.). Health Care Workforce Challenges Threaten Hospitals’ Ability to Care for Patients. https://www.aha.org/fact-sheets/2021-11-01-data-brief-health-care-workforce-challenges-threaten-hospitals-ability-care
Aiken, L. and R. Cheung (2008), “Nurse Workforce Challenges in the United States: Implications for Policy”, OECD Health Working Papers, No. 35, OECD Publishing, Paris, https://doi.org/10.1787/236153608331Links to an external site..
Birk, H. S. (2016). United States National Healthcare Policies 2015: An Analysis with Implications for the Future of Medicine. Cureus, 8(1)https://doi.org/10.7759/cureus.451Links to an external site.
Institute of Medicine. (2008). Evidence-Based Medicine and the Changing Nature of Healthcare: 2007 IOM Annual Meeting Summary. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK52830/Links to an external site.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice Links to an external site.Links to an external site.. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from
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Collapse SubdiscussionIris Cornell Tammy response from the instructor
Tammy thanks for sharing good competing needs and developing policies. On your unit does any of the staff participate in policy development?
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Collapse SubdiscussionTammy Young Dr Cornell, thank you for the response. To answer your question, yes the staff on my unit do participate in policy development. The hospital holds quarterly meetings where each unit is represented by at least two nurses, the nursing director and at least one physician. We have seen policy changes and development that directly impact how we care for patients.
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Collapse SubdiscussionIvy Dzivenu MAIN POST
Complaints about rising healthcare expenditures are common in today’s healthcare. Due to the nature of the healthcare industry, competing needs often exist. It is especially true when it comes to the technology doctor-patient relationships, where the patient wants more attention and time from their doctor, but there are only a certain number of hours in a day. According to Kelly & Porr (2018), healthcare expense has possibly increased at a noticeably rapid rate in recent years. It has mostly been attributed to the requirement to switch from an analog to a digital style of healthcare delivery. This change has been described as expensive yet necessary for the modern healthcare society to achieve the desired results, as stated by American Nurses Association (2015). Since most of the policies being developed are in accordance with digital migration and the embrace of technology, the formulation of healthcare policies has become fairly difficult as a result of these rising costs. Each policy is perceived to have a negative impact on healthcare.
However, this has led to an ethical dilemma at work. Technology has helped address some of the most difficult medical issues, and it has also allowed for the commercialization of drugs that were previously unavailable. Through screening, which is carried out using advanced technological tools to observe the inside of the human body, some diseases, such as cancer, are rapidly diagnosed (Barba et al., 2021). In theory, this is a great step toward better healthcare and eradicating some of the deadliest diseases in the world. However, as technology has developed, fewer people can obtain healthcare, at least not without an insurance plan. Policymakers must explore ways to enhance financing for research and therapy to ensure that people suffering from different diseases can get the care they need.
The impacts of these competing needs include how technology makes better access to medical data and information possible. Our improved capacity for data storage and access has been one of the major advantages of the digital revolution. Now, healthcare professionals may access patient data from any location. Now, healthcare practitioners can quickly communicate medical data through the intranet and the internet, enhancing patient care. To view the results of their tests, patients may visit their EHR on the patient portal without having to call the doctor’s office. (“Intelligence Retinal Imaging Systems,” n.d.). However, this has been faced with a setback in data loss and breaches since care teams can coordinate decision-making using the same current information.
Furthermore, the time that the office personnel spends on the phone exchanging information and moving paperwork can be reduced. The problem with technological requirements is portability. However, an increasing number of technology firms are starting to recognize this problem and provide EHR connectors that enable adopting new technologies easier. However, policymakers will be up to considering how to increase access to care so those who need care can get the assistance they require. Policymakers must also weigh these and other competing objectives to create effective plans to tackle illnesses.
Technology also improves access to care. Healthcare access is one of the biggest barriers to providing high-quality care. Because they cannot receive the required care owing to physical, location, and cost limitations, patients frequently face treatment delays (AlQudah et al., 2021). “Advantaged populations are particularly impacted, and clinicians can give them solutions that will enable them to benefit from healthcare technology” (Healthmanagement.org, 2020). As a result, policymakers need to focus on setting rules limiting how telehealth can decrease the number of trips patients take to the emergency room while lowering expenditures for providers and patients. Rather than communicating and assessing patients and instructing them online, there is a need for portable diagnostic equipment which can help treat patients in their local areas.
Remote patient monitoring can lower healthcare costs by averting future effects, much like earlier issue discovery. Using remote monitoring and telehealth, it is also possible to address the problem of a lack of physicians in rural areas, which has plagued many countries, including ours. However, according to Galen Data (2022), “there may be issues because technology has evolved over the year, thus serving as the conduit between clinicians and patients.” A happy, delighted doctor administers medication to his patient. Working with dashboards on connected medical equipment and computers removes the human touch of therapy, which results in a lack of compassion for patient care. Policymakers should develop laws that shield patients since using technology as an interface for treatment may confuse and frustrate individuals, especially elderly and disadvantaged patients. It could also result in client disobedience or confusion about treatment strategies.
The necessity for technology and the ensuing rise in expenses have caused a serious issue for the medical community. Technology is a necessary component of today’s environment, but what good is a highly technologically advanced institution if its costs are so high that it excludes a sizable portion of the population it is intended to serve? For instance, cancer can be easily detected and tracked today, but it is quite expensive, and only the wealthy can afford it. Since most members of the lower middle class and the poor cannot afford these services and are likely to pass away from their illness, this is unethical (Milliken, 2018). Therefore, it is crucial for today’s healthcare leaders to develop regulations that guarantee that prices are significantly restricted as technology improves.
References
AlQudah, A. A., Salloum, S. A., & Shaalan, K. (2021). The role of technology acceptance in healthcare to mitigate COVID-19 outbreak. Emerging Technologies During the Era of COVID-19 Pandemic, 223-244. https://www.researchgate.net/profile/Said-Salloum/publication/350277489
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-only
Barba, D., León-Sosa, A., Lugo, P., Suquillo, D., Torres, F., Surre, F., … & Caicedo, A. (2021). Breast cancer, screening, and diagnostic tools: All you need to know. Critical Reviews in Oncology/Hematology, 157, 103174. https://hal.archives-ouvertes.fr/hal-03218320/file/Breast_cancer.pdf
Galen Data. (n.d.). The disadvantages of technology in Healthcare – Galen Data. https://www.galendata.com/disadvantages-of-technology-in-healthcare/
HealthManagement.org. (2020, February 20). The impact of digital technology on healthcare. HealthManagement. https://healthmanagement.org/c/cardio/news/the-impact-of-digital-technology-on-healthcare
Intelligent Retinal Imaging Systems. (n.d.). Top 3 benefits of technology in healthcare – iris. IRIS. https://retinalscreenings.com/blog/top-benefits-of-technology-in-healthcare/
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1). Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html
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Collapse SubdiscussionTiffany Johnson Discussion Response 2
Hi Ivy,
Thank you for your post. I agree that the technology is needed to keep progressing in the healthcare world. I never put the cost of new technologies and rising healthcare costs together. It provides such a great benefit for providers and patients. Patients have access to their care any time of day which is beneficial if the providers offices are closed. The downside of this is they may have questions regarding their care. This could create anxiety for the patients if they see updated healthcare results after hours. Some providers believe that technology will help them have more time in their day and help them with getting timely health information to their patients. Some of the barriers they perceive are that it will decrease the patient-provider relationships, decrease their autonomy, and there is a security risk versus paper (Morad Abdulah & Ali Perot, 2022). Something I am excited about that is coming down the pike is the ability for electronic health records to be available across all platforms. The Office of the National Coordinator for Health Information Technology (ONC) created the Trusted Exchange Framework and Qualified Health Information Network (QHIN) Technical Framework in January of 2022 (The Office of the National Coordinator for Health Information Technology, n.d.). The goal of this program is for all platforms like EPIC and Meditech to be able to share medical information in a secure manner (ONC, n.d.). The ONC has approved funding to assist in the project to the tune of nine hundred and forty-two thousand dollars (ONC, n.d.). I am sure that some of that funding comes from taxpayers and of course yet more of an increase in healthcare costs. The electronic health record companies will have to apply to be part of The QHIN which I am sure will have a fee attached to help offset some of those increases that could be handed down to the consumers. This project will be beneficial to both providers and patients when it happens by allowing providers to see all of the medications and care patients have received.
References
Morad Abdulah, D., & Ali Perot, K. (2022). Barriers and benefits of adopting electronic health records (ehrs) in public hospitals. Health Problems of Civilization, 16(1), 93–107. https://doi.org/10.5114/hpc.2022.113596Links to an external site.
The Office of the National Coordinator for Health Information Technology. (n.d.). Trusted exchange framework and common agreement (tefca). HealthIT.gov. https://www.healthit.gov/topic/interoperability/policy/trusted-exchange-framework-and-common-agreement-tefcaLinks to an external site.
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Collapse SubdiscussionAbie Kamara main post
Although the US healthcare system may look perfect compared to other developing nations, it still faces various issues affecting its smooth operation. Similar to other industries, the healthcare industry in the US is constantly adapting to meet the needs of its customers.
One of the most common issues that the US government and Congress must tackle is the rising cost of prescription medications. This issue has been drawing attention from both political and media circles. The government and the private sectors must work together to develop effective strategies and policies to make healthcare more affordable for all Americans(Coleman & Berenson, 2004).
Prescription drugs are among the national healthcare issues headlines in political and media circles.How competing needs may impact the development of policy
Like other industries, the healthcare industry also has multiple competing needs. These needs are mainly caused by the stakeholders’ desire to provide the best possible care to the patients. To address these needs, the industry should develop a comprehensive policy that will help address them.
Today’s healthcare industry has multiple competing needs. These include the workforce, the availability of resources, and the rising number of patients. The current patients are composed of a considerable number of millennials.
The needs of the new generation are unique and require the industry to adapt to meet them. Due to the rise of technology, hospitals are now more likely to adopt policies that cater to their needs. In addition, the healthcare industry is also populated by millennials, who have varying work-related requirements.
Some of these include better work conditions, increased payments, and the use of technology in performing various clinical processes. Unfortunately, the resources used for healthcare have been overused. The federal and state governments have limited funds that they can use to meet certain activities and requirements within the industry.
The government and the various stakeholder groups in the healthcare industry should work together to develop policies that will address these competing needs.Competing needs that may impact the rising cost of prescription drugs
The rising cost of prescription drugs has been a concern for the government and various stakeholder groups in the healthcare industry. Although it is the right for patients to access the medications they can afford, the affordability of some commonly used medicines can be affected by competing needs.
One of the competing needs is the low level of negotiation power that the country’s healthcare system has with pharmaceutical companies. This is because the method comprises both public and private payers, which can make it difficult for them to negotiate lower prices.
Another competing need is the availability of the right drugs for the patients. This is because manufacturing companies are under increasing pressure to meet the quality of their products, leading to higher prices for their medications. Due to this, the US Congress has been considering various bills to regulate prescription drug prices.
One of the proposals made during the 2017 legislative session was the American Health Care Act. Although it did not pass, it was designed to lower the prices of certain medicines.
Conclusion
One of the main priorities of any government is providing affordable and accessible healthcare. Unfortunately, it has been very challenging to implement effective measures to control the prices of prescription drugs in the US. Despite the various proposals that have been presented, the government still needs to come up with a strongReferences
Recovering the us mental healthcare system (1st ed.). (2022). Cambridge University Press.
American College of Physicians. Annals of internal medicine, 165(1), 50-52.
Coleman, E. A., & Berenson, R. A. (2004). Lost in transition: challenges and opportunities for improving the quality of transitional care. Annals of internal medicine, 141(7), 533-536.
Daniel, H. (2016). Stemming the escalating cost of prescription drugs: a position paper of the
Kesselheim, A. S., Avorn, J., & Sarpatwari, A. (2016). The high cost of prescription drugs in the United States: origins and prospects for reform. Jama, 316(8), 858-871
McCarthy, M. (2015). Drug’s 5000% price rise puts spotlight on soaring US drug costs.
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Collapse SubdiscussionIris Cornell Abie response from the instructor
Abie thanks for sharing. Robichaux (2012) mentioned that in nursing we need “practical strategies to enhance ethical skills such as the development of nursing ethics groups and providing continuing ethics education” (Abstract), is needed. In your organization do they promote practical strategies and continuing ethics education to staff?
Reference
Robichaux C. (2012). Developing ethical skills: from sensitivity to action. Critical Care Nurse, 32(2), 65–72. https://doi.org/10.4037/ccn2012929
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Collapse SubdiscussionAbie Kamara Dr Cornell, thank you for the response.My organization offers continuing ethics education and practical strategies to its staff members.
This ensures that our staff members are competent and able to provide effective and compassionate care to our clients. It also helps us protect ourselves from ethical complaints and litigation. Ethics education is a part of most medical /nursing school degrees.
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Collapse SubdiscussionIvy Dzivenu RESPONSE #1
Hi Abie,
Great post. Very educative. I agree with your statement “Due to the rise of technology, hospitals are now more likely to adopt policies that cater to their needs”. Technology needs also have a significant impact on improved lines of communication. Healthcare professionals once communicated using a beeper. However, communication between patients and healthcare professionals is now relatively straightforward because of digital technologies. Healthcare personnel can interact through text messages, cell phones, and other devices (Healthmanagement.org, 2020). Doctors are no longer required to mail letters reminding patients of their appointments and testing. Technology has made everything much easier and more economical. However, policymakers need to set rules that govern and protect patients from medical practitioners’ use of technology, such as films and webinars, to communicate with their colleagues. It will be simple to control some of the negative impacts resulting from technology as a competing need.
References
HealthManagement.org. (2020, February 20). The impact of digital technology on healthcare. HealthManagement. https://healthmanagement.org/c/cardio/news/the-impact-of-digital-technology-on-healthcareLinks to an external site.
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Collapse SubdiscussionFatimah Johnson Hello Abie,
Thank you for speaking on the high costs of prescription drugs. All individuals should be granted universal healthcare, as healthcare is right and not a privilege. An estimated 25% of Americans find high out-of-pocket costs for prescription drugs challenging to afford (Vincent Rajkumar, 2019). The question is, why are most prescription drugs unaffordable? Vincent Rajkumar (2019) continues that monopoly, the seriousness of the disease, drug development costs, and pharmaceutical lobbying contribute to rising expenses. However, monopoly and lack of alternatives seem to be the most prominent reasons.
President Biden introduced the Inflation Reduction Act of 2022. According to The White House (2022), this legislation helps families by cutting prescription and healthcare costs, defeating special interests, and lowering energy costs. The Inflation Reduction Act also requests large corporations pay their fair share in costs. This act strives to lift Americans and improve the economy of working families.
References
The White House. (2022, August 15). By the numbers: The inflation reduction act. https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/15/by-the-numbers-the-inflation-reduction-act/Links to an external site.
Vincent Rajkumar, S. (2020). The high cost of prescription drugs: Causes and solutions. Blood Cancer Journal, 10(6). https://doi.org/10.1038/s41408-020-0338-xLinks to an external site.
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Collapse SubdiscussionMleh Porter Hello Abie,
Thank you for your post on the health issue of the rising cost of prescription drugs. In 2019 the United States spent $370 billion on prescription medications, and the prescription drug spending rate is projected to increase by 3-6% annually around the globe (Rajkumar, 2020). In 2021, the United States healthcare system spent about $421 billion on retail drugs alone. About 1216 drugs saw an average increase of 31.6% between 2021 and 2022 (U.S. Department of Health and Human Services, 2022). Unfortunately, this high cost of prescription drugs takes up most of the healthcare budgets, limiting the funding that could be invested in other areas. The increased prescription drug cost also leaves unfordable out-of-pocket costs for many patients. About 25% of Americans cannot afford prescription medications due to the high out-of-pocket costs (Rajkumar, 2020).
Healthcare, including prescription drugs, should be accessible to all, but that is not the case, especially with the competing needs that distract from addressing healthcare issues. You mentioned the poor negotiations between healthcare systems and pharmaceutical companies and the availability of the proper medication for the patient as competing needs. Additional competing demands include the high cost of developing some of these medications, monopoly, and the lobbying power of pharmaceutical companies. In 2018, pharmaceutical companies and their organization spent about $220 billion lobbying in the United States, making it difficult to implement policies that combat the rising price of prescriptions (Rajkumar, 2020). Monopoly has been identified as the most crucial reason for the increasing cost of prescription drugs. Policies to reduce the patent life of medications should be implemented to allow for alternate medicines, which will help reduce the cost of the medicine. Pharmaceutical companies try to prong the life of drug patents, resulting in a long patent life of medicines. In addition, policies to cap the prices of medicines should also be implemented. The United States spends significantly more on existing medications because there is no cap on the prices of these medications compared to other countries (Rajkumar, 2020).
References
Vincent Rajkumar S. (2020). The high cost of prescription drugs: Causes and solutions. Blood Cancer Journal, 10(6), 71. https://doi.org/10.1038/s41408-020-0338-xLinks to an external site.
U.S. Department of Health and Human Services. (2022, September 30). New HHS reports illustrate potential positive impact of inflation reduction act on prescription drug prices. HHS.gov. https://www.hhs.gov/about/news/2022/09/30/new-hhs-reports-illustrate-potential-positive-impact-inflation-reduction-act-prescription-drug-prices.html
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Collapse SubdiscussionSergio Aguirre Main Post:
Dr. Cornell and class,
By 2026, the U.S. Bureau of Labor Statistics anticipates the shortage of over 200,000 nurses (Marklund, et al., 2022). Nursing shortages are already affecting healthcare organizations. Anyone who has recently worked in the medical field, particularly during the COVID pandemic could attest to this. Needs from patients and staff (nurses, and physicians) often affect each other, and may frequently cause ethical concerns. Nurses are asked to be nurse assistants, environmental service, lab techs, and orderlies all in one. With heavy workloads, nurses are still required to provide great service, without room for error.
Nursing shortages have been an issue for quite a while. Some measures my healthcare organizations is taking to provide adequate staffing, is to have a policy of hiring travel nurses, and offering external contracts. California gets many travel nurses from different parts of the country due to high wages. Travel nursing was booming during the pandemic, and huge contract of up to $10,000 a week were being offered. Travel nurses help out immensely but it’s a temporary fix, to the demand issues, as travel nurse bounce around, similar to mercenaries. More recent measures include offering sign on bonus of up to $20,000 and increasing full time staff wages, which have been implemented in order to promote nursing retention.
Frequently staffing is so short, that we tend to practice out of ratio. California has laws regarding patient staff ratios and is the only state to have particular ratios in each hospital unit (Davidson, 2022). In the Emergency Department, the ratio is 4:1, and if you have critically care patients it drops down to 2:1 (Davidson, 2022). Due to our nursing shortages, these ratios are often not followed. Countless times, I have taken care of two Diabetic Keto Acidosis, and an additional lesser acuity patient. This can lead to ethical concerns as less time, is spent on the lesser acuity patients. Nursing must have an ethical awareness to them, in order to recognize risk that nursing actions or inactions can cause (Milliken, 2018). It is easy to violate ethical principle in this case and is a prime example of competing needs in a healthcare setting (Milliken, 2018).
A policy that has had varied success is a nursing student extern program. The extern program allows students from a particular junior college to work during their nursing program. The student must be in the second semester or further and must be in good standing with their junior college. The nursing student starts off slowly and learns how to work independently with the goal of being mostly independent by the time they have completed their studies. Some students enjoy this experience and many end-up staying long term.
Other policies implemented to assist with provider staffing are using Nurse Practitioners (NP’s) in provider roles. NP’s assist with Cardiologist, and ED providers at night. Physician’s Assistant also help out in our urgent center and fast track areas. Overall it’s an uphill battle, but one that must be done to provide adequate and satisfactory patient care.
Reference
Davidson, A. (2022, September 15). Nurse-to-Patient Staffing Ratio Laws and Regulations by
State. Nurse Journal. https://nursejournal.org/articles/nurse-to-patient-staffing-ratio-laws-by-Links to an external site.state/
Marklund, L., Nohrenberg, J., & Mulcahy, A. (2022). COVID-19 Pandemic: The Importance of
Supporting Civilian and Military Transition-to-Practice Programs to Avert Current and Future
Nursing Shortages. Journal for Nurses in Professional Development, 38 (3),
https://doi: 10.1097/NND.0000000000000751
Milliken, A. (2018). Ethical awareness: What is it and why it matters. OJIN: Online Journal of
Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html
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Collapse SubdiscussionTammy Young Sergio, I found you post to be most informative, especially regarding the specifics to nursing care in California.
The political system affects the quality of health care and how it is delivered in the United States. Providing high-quality care is an important goal that entails defining and focusing on value as an important opportunity to spark and even facilitate improvement in all aspects of health care. Successfully creating and changing healthcare policies requires a specific goal, consensus on the problem, and a public-private partnership on how to provide the solution. (Aiken & Chung, 2008).
I experience the effects of the nursing shortage daily and find the competing need for understaffing exponentially increasing. One Health and Human Services study projected that by 2030, the demand for registered nurses would hit more than 3.6 million in the US ( Haines, 2022). As the hospital experiences an increased rate of nurse turnover, the acuity of the patients only increases. With a decreasing number of ancillary staff members, nurses are expected to carry out the time-consuming tasks typically completed by the CMA, housekeeping, transport staff, or lab staff. About 3 in 10 healthcare workers considered leaving their profession, and about 6 in 10 said pandemic-related stress had harmed their mental health, according to a study from the Kaiser foundation. Due to this burnout, hospitals are experiencing critical staffing shortages (American Hospital Association, n.d). Nurses struggle with the moral/ethical decision-making process deeply rooted in their education and experiences when forced to care for more patients with higher acuity than what is realistic and safe. RNs can become apathetic or disengaged to the point of being unkind and non-compassionate when they are not supported in a way that allows them to deliver ethical care (Kelly & Poor, 2018).
Improving the nursing shortage is a multifaceted undertaking. This national shortage primarily affects how healthcare policies are written and adopted (Aiken& Cheung, 2008). Policymakers must prioritize funding policies to expand and retain the healthcare workforce and increase nursing programs’ capacity (American Hospital Association, n.d.). In addition, nurses must take an active role in policy-making as they are the front-line workers who know from personal experience what it takes to provide proper patient care. A study showed that the active involvement of nurses in the policy-making process is essential to reducing nursing shortages. (Abhicharttibutra, 2017).
Abhicharttibutra, K., Kunaviktikul, W., Turale, S., Wichaikhum, O. A., & Srisuphan, W. (2017). Analysis of a government policy to address nursing shortage and nursing education quality. International nursing review, 64(1), 22–32. https://doi.org/10.1111/inr.12257Links to an external site.
American Hospital Association, (n.d.). Health Care Workforce Challenges Threaten Hospitals’ Ability to Care for Patients. https://www.aha.org/fact-sheets/2021-11-01-data-brief-health-care-workforce-challenges-threaten-hospitals-ability-careLinks to an external site.
Aiken, L. and R. Cheung (2008), “Nurse Workforce Challenges in the United States: Implications for Policy”, OECD Health Working Papers, No. 35, OECD Publishing, Paris, https://doi.org/10.1787/236153608331Links to an external site..
Haines, J. (2022) US News and World Report; The State of the Nation’s Nursing Shortage. https://www.usnews.com/news/health-news/articles/2022-11-01/the-state-of-the-nations-nursing-shortageLinks to an external site.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice Links to an external site.Links to an external site.. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from
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Collapse SubdiscussionJeanne Baleng Okuwobi Hello Sergio,
The shortage will continue to affect the healthcare system if essential measures are not implemented to prevent it from worsening. I believe it will cost less for healthcare organizations to invest in keeping their full-time staff because agency nurses make two to three times compared to traditional staff. In 2021 travel nurses made at least three times what their full-time staff co-workers made (Covid-19’s impact on nursing shortages, the rise of travel nurses 2022). In addition, if the organization offers resources that help the well-being of nurses, such as assessing the level of stress of staff, paying attention to emotional and mental well-being, implementing other hourly shifts besides the traditional 12 hours, establishing supportive institutional policies, providing adequate PPE, and provide staff social support. (Strategies for managing a surge in healthcare provider demand, 2021).
References
Covid-19’s impact on nursing shortages, the rise of travel nurses. (2022, January 28). Available from https://www.healthaffairs.org/do/10.1377/forefront.20220125.695159
Strategies for managing a surge in healthcare provider demand. (2021, November). Available https://files.asprtracie.hhs.gov/documents/healthcare-workforce-strategies-for-managing-a-surge-in-healthcare-provider-demand.pdf
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Collapse SubdiscussionNavtej P Singh Hi Sergio,
Thank you for a classic example of California law that fixes the ratio of staff to patient, but the ground reality does not change. I live in the state of Washington, and nurses attempted to bring similar laws but failed to pass them in the state senate. However, the ANA (American Nursing Association) has position that the nursing in hospitals shall work with the administration to find the best nursing staffing models (Nurse Staffing (2019). As you pointed out in your discussion, nurses continue to work understaffed even in the face of clear state law. The violation of these laws carries no penalties of very minimal peril for not following the law.
However, In the state of Washington, we have a law that each hospital must have a Joint nurse staffing committee to find the appropriate staffing levels for the hospital. The hospital created a policy to have such a committee, and there are regular meetings with the chief nursing officer (CNO) and their team. This joint nursing committee agreed to a nursing staffing plan, but the CEO shot down this plan. This is a very sad situation that even the top nursing management did not have much say regarding hospital profits. When the legislation was proposed, it was supported by the Washington State Hospital Association (WSHA). However, hospitals all across the state failed to implement the finding of the committee that was formed with hospital management in present. Hospitals have many excuses not to abide by the rules when they sit with nurses, and all seem to agree based on care. Believe me, this kind of behavior by the administration breaks my heart and patient care.
Reference:
Nurse staffing. (2019, July 11). ANA. https://www.nursingworld.org/practice-policy/nurse-staffing/Links to an external site.
Sauer, C. (2022). Staffing legislation’s one-size-fits-all approach will increase costs & delay care –
Washington state hospital association. Washington State Hospital Association. https://www.wsha.org/articles/staffing-legislations-one-size-fits-all-approach-will-increase-costs-delay-careLinks to an external site.
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Collapse SubdiscussionDinorah Abigail De La Cerda Dinorah de la Cerda
Main Post Wk 3
Competing Needs and the Impact on Policy Development
As reported in Gallup’s annual rating, nurses are the number one trusted profession and have been for the last 20 years (Saad, 2022). Nurses are trusted because patients can see how we advocate for them, care for them, and work hard to provide healing environments. Policies are written to have accountability in the workplace; for example, in the hospital I work, only dialysis nurses and ICU intensivists are allowed to access dialysis catheters, and ER physicians may do so in case of an emergency. This policy was put in place for the safety of patients and to protect the hospital. Provision seven of the ANA Code of Ethics outlines a nurse’s obligation for advocacy, including policy-making. Provision six outlines the responsibility of a nurse to provide ethical and quality care (ANA, 2015).
Nursing Shortages and Competing Needs
One of the main issues impacting today’s nursing workforce is the lack thereof. The nursing shortage has allowed for a negative impact on patient safety. This need for more staff has affected policymakers as they try to adjust policy to alleviate this shift. Some states have loosened licensing requirements and offered incentives. The state of Kentucky even allowed temporary work permits for foreign nursing school graduates pursuing licensure to cope with the demands (Enlud, 2022). In the ED, our supervisors were constantly hounding us about our staffing numbers; during the slow days, they sent all the nurses home or placed them on call to allow for the budget to remain “in the green.” This often leaves one charge nurse dealing with two or more sections, a triage nurse, and one nurse inside the unit, placing unnecessary strain on the staff and techs. I understand that staffing is hard to predict, and one can never guess how many patients the hospital will receive in one day. However, continuously working short contributes to burnout and ultimately can make a nurse quit. Nursing burnout also contributes to poor patient satisfaction and places patients at risk of preventable errors (Haddad et al., 2022). Nurses should not jeopardize their license, health, or safety to compensate for the lack of nursing staff. Instead, we should advocate for ourselves in our respective workplaces.
Policy and Competing Needs
Texas has created a program to help combat the nursing shortage. It is called “The Nursing Shortage Reduction Program”; it was authorized in 2001 and updated in 2021. It is a program that helps educate prospective nursing students. The program is “highly effective and has room to grow” (The nursing shortage reduction program, n.d ). Other policies like The Registered Nurse Safe Staffing Act of 2015, which requires safe staffing, make hospitals accountable for their nurse staffing (S.1132 – 114th congress, 2015-2016). As stated in the ANA, it is our responsibility to provide safe, ethical, quality care; without safe staffing, it is impossible.
Conclusion
Nurses should not be required to jeopardize their health or patients’ health. Creating incentives, making schools more accessible, and taking care of the current staff’s needs are all ways to combat the shortage issue. Existing policies should be updated, and new approaches should be made to manage this issue.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD. https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Enlund, S. (2022, June 20). Addressing Nursing Shortages: Options for States. National Conference of State Legislatures. https://www.ncsl.org/research/health/addressing-nursing-shortages-options-for-states.aspxLinks to an external site.
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022, February 22). Nursing shortage – statpearls . https://www.ncbi.nlm.nih.gov/books/NBK493175/
S.1132 – 114th congress (2015-2016): Registered nurse safe … (n.d.). Retrieved December 15, 2022, from https://www.congress.gov/bill/114th-congress/senate-bill/1132/text
Saad, L. (2022, January 12). Gallup. Military Brass, Judges Among Professions at New Image Lows. https://news.gallup.com/poll/388649/military-brass-judges-among-professions-new-image-lows.aspxLinks to an external site.
The nursing shortage reduction program. Texas Nurses Association. (n.d.).https://cdn.ymaws.com/www.texasnurses.org/resource/resmgr/docs/gac/2022/Nursing_Shortage_Reduction_P.pdf
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Collapse SubdiscussionKasondra Lewis Main Post: Competing Needs and Policy Development
Nurses are tasked with many duties throughout our careers, even during a single shift. However, one of our fundamental responsibilities is to maintain ethics at various levels. According to the American Nurses Association (2015), nurses must make an effort individually and together to create, maintain and improve the work setting ethically to ensure quality care. Nurses can ensure that the working environment remains ethical by recognizing the need for change and advocating for change. For example, research from Hill (2020) details changes made to nurse-to-patient ratios supported by the UK Critical Care Nursing Alliance. Before 2020 no changes had been made regarding nurse-to-patient ratios since 1967; the COVID-19 pandemic shed light on unsafe working conditions created by unchanged ratios that had been in place for decades. The need for change supported by nurses resulted in the National Health Service in England enacting change to ratios, which lessened the number of critical patients one nurse could care for at a given time.
Nursing Shortages and Retention: Competing Needs
Issues creating nursing shortages must be examined so changes can be made to impact the field positively. Nursing shortages have been linked to fewer nurses entering the field and the inability to retain nurses (Foster, 2022). The nursing shortage has created a working and care environment that is unsatisfactory for nurses and patients (Lu et al., 2019). Essentially, the workforce needs more nurses to meet the needs of staff and patients. The shortage of nurses has impacted both nurses and patients negatively. For example, patients experience adverse outcomes, and nurses are becoming more dissatisfied with their careers because of the rising shortage of nurses (Ross, 2022).
Nursing Shortages and Retention: Policy Development
Changes to nurse-to-patient ratios have been proven to increase nurse satisfaction and patient outcomes (Hill, 2020). Because of the rising shortage of nurses available in the field, decreasing the nurse-to-patient ratio seems like an undoable task. However, if ratios are decreased, nurse satisfaction will likely rise, increasing nurse satisfaction and improving patient outcomes. Changing policy to support workload-intensity staffing instead of following the current nurse-to-patient ratio guidelines has produced a positive change within the nursing workforce (Bacon et al., 2022). Traditionally, the nurse-to-patient ratio is set per department, regardless of patient acuity. For example, recently, in the Emergency Department, I was the primary nurse for an intubated patient, a patient with an acute head injury, a patient requiring multiple blood transfusions, and chest pain simultaneously. The nurse-to-patient ratio in this unit is 1:4. Because of limited staffing, I received minimal help during this time. If nurse-to-patient ratios changed to reflect workload intensity, I could have spent more time with each patient and provided a greater level of care.
References
American Nurses Association. (2015). Code of Ethics for Nurses With Interpretive Statements. Nursing World. https://www.nursingworld.org/coe-view-only
Links to an external site.Bacon, C. T., Gontarz, J., & Jenkins, M. (2022). Transitioning from Nurse-Patient Ratios to Workload Intensity Staffing. JONA: The Journal of Nursing Administration, 52(7/8), 413–418. https://doi.org/10.1097/nna.0000000000001174
Links to an external site.Lu, H., Zhao, Y., & While, A. (2019). Job satisfaction among hospital nurses: A literature review. International Journal of Nursing Studies, 94, 21–31. https://doi.org/10.1016/j.ijnurstu.2019.01.011
Links to an external site.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
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
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Collapse SubdiscussionSergio Aguirre Hello Kasondra and class,
It sounds like you had a challenging shift with, as you had a full workload on top of your critical patient. Unfortunately, this is a common theme in emergency departments, and may lead to ethical challenges, regarding patient management and distribution of time and resources. Healthcare organizations, are not always designed to support the Nursing Code of Ethics, rather pushes for the business model of healthcare which focuses on institutional savings, and acceptance of organizational norms such as working out of ratio, and working short staffed (Kelly & Porr, 2018). In addition, heavy workloads, may lead to anxiety, stress, and burnout. Surveys frequently show that nurses are stressed, and overworked, and have reported concerns about their safety and health (Bardhan et al., 2019). Burnout may lead to nurses leaving their jobs, and the profession altogether thus continuing the cycle of nursing shortages.
References
Bardhan, R., Heaton, K., Davis, M., Chen, P., Dickinson, D & Lungu, C. (2019). A Cross Sectional
Study Evaluating Psychosocial Job Stress and Health Risk in Emergency Department Nurses.
International journal of environmental research and public health 16(18),
https://doi:10.3390/ijerph16183243Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN:
Online Journal of Issues in Nursing, 23(1), https://doi:10.3912/OJIN.
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Collapse SubdiscussionDinorah Abigail De La Cerda Response # 2 Wk 3
Kasondra,
Your post was very informative. I think it is essential to look at what other countries are doing to retain or fix the issues we have with staffing. On top of everything nurses deal with, like death and stress, nurses are too often abused by patients and staff. Workplace violence is an issue within itself but is also a reason for the nursing shortage. Currently, there is no law that “require(s) employers to implement workplace violence prevention” (workplace violence, 2021). Hospitals could retain nurses and fix the nursing shortage issue if there was a policy around protecting nurses and enhancing the workplace.
After all, nurses are in a great position to guide policies in the workplace regarding the reasons for burnout and high turnover (Kelly & Poor, 2018).
References
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.htmlLinks to an external site.Workplace violence. ANA. (2021, March). https://www.nursingworld.org/practice-policy/advocacy/state/workplace-violence2/
Workplace violence. ANA. (2021, March). https://www.nursingworld.org/practice-policy/advocacy/state/workplace-violence2/
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Collapse SubdiscussionJulie Robinson Hello Dr. Cornell and class,
How Competing Needs Impact Policy Development
The moral climate that requires polite interactions between groups, mutual support from peers, and direct identification of tough challenges is one that nurses are expected to contribute to (American Nurses Association, 2015). Nurses must be able to identify and handle ethical dilemmas as they occur, given the complexity of today’s healthcare systems (Kelly and Porr, 2018). This includes continual professional development of staff in ethical problem-solving. For example, A culture of respect needs to be built and maintained by leaders (Broome and Marshall, 2021).
Specific Competing Needs that Impact Incivility
Although difficulties and circumstances pose the most glaring, dramatic hazards to patients, everyday nursing acts also impact them. Future leaders are challenged to look beyond these suggestions to pinpoint the issues in particular work environments, even while the ANA and other organizations offer valuable coverage of tactics and resources that may avoid and manage incidents of incivility (Broome and Marshall, 2021). Zero-tolerance policies and suggestions, for instance, are frequently implemented and may appear to be successful strategies. Still, their effectiveness is limited because they have not addressed the underlying causes of disrespect, bullying, and violence. For example, nursing administrators must consider overtime, a high staff turnover rate, poor patient-to-nurse ratios, ongoing changes to policies and procedures, and organizational norms that may contribute to incivility (Broome and Marshall, 2021).
How Policy Address These Competing Needs
Nurses must be able to identify and handle ethical dilemmas as they occur, given the complexity of today’s healthcare systems. Although difficulties and difficult circumstances pose the most glaring, dramatic hazards to patients, everyday nursing acts also impact them (Milliken, 2018). For example, regarding addressing the competing needs of policy, leaders must be obligated to critically assess their organizational procedures not only to identify and denounce people who act violently and uncivilly at work but also to try to change the environments that encourage such behavior. Having nursing leaders constantly working towards a safe work environment will allow nurses to thrive at what they do best, patient care!
References
American Nurses Association. (2015, November 25). Code of ethics for nurses with interpretive statements. Nursing World. https://www.nursingworld.org/Links to an external site.
Broome, M., & Marshall, E. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man06Links to an external site.
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man01Links to an external site.
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Collapse SubdiscussionIris Cornell Julie a response from the instructor
Julie thanks for sharing a good policy. How can staff be confident that ethical awareness has been considered in policy development?
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Collapse SubdiscussionJulie Robinson Hello Dr. Cornell and class,
Thank you for your question. Staff can find ethical awareness in policy by looking toward leadership. I say this cause, at my current facility, leadership means something. Our leaders hold policy to the highest standard. They would take action if a policy were to be broken just a bit. Our leaders hold anyone accountable for violating this policy and take immediate action. I believe that if every leader at each facility did the same, incivility might be low in the nursing workforce.
I hope I answered your question, Dr. Cornell. I hope that you have a fabulous rest of your day. Thank you again.
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Collapse SubdiscussionJessica Slavin WK3 Main Post NURS6053
After reading the required resources, it’s hard to not stick with the ongoing topic of short staffing as the number one national healthcare issue because it is impactful in so many aspects. Management & leadership roles believe this deficit affects patients the most, but I’d like to give a different perspective and discuss ethically how it is affecting us as nurses and our decision to continue our careers in this very difficult industry.
Duty to self and Others
“Moral respect accords moral worth and dignity to all human beings regardless of their personal attributes and life situation. Such respect extends to oneself as well; the same duties that we owe to others we owe to ourselves. Self-regarding duties primarily concern oneself and include promotion of health and safety, preservation of wholeness of character and integrity, maintenance of competence, and continuation of personal and professional growth” (American Nurses Association 2015).
As nurses, we extend grace to our patients daily, often times we give up our own needs including our families during a 12-hour shift to meet those of others. I can guarantee all of us at some point in our careers have given up a lunch break or stayed over late to ensure patients received medications on time, personal care, dressing changes, and an endless list of physician orders. We miss sporting events, school activities, and milestones with our growing families due to long shifts and increasing needs for healthcare. So, when is our time going to be considered just as important as the patient care we provide, why are we not extending the same grace to ourselves in self-care mentally and physically as we do the healthcare systems we commit to daily?
Nurse leaders have a responsibility to shape ethical cultures using the knowledge of ethical standards in the discipline and expert guidelines outlined in the following principles of ethical leadership: respect for others, beneficence, veracity, fidelity, nonmaleficence, justice, and autonomy (Broome & Marshall, 2021, p. 8). Although these principles are over a decade old, I believe they still stand firm in true leadership today except for autonomy. Increasing patients’ needs and demands from management leave little room for promoting personal freedom and the right to choose what best works for our lifestyles.
The old statement rings true, “you can’t pour from an empty cup”. An article discussing workplace environments in regard to the quadruple aim states “Creating healthy professional practice/work environments (PPWEs) for nursing practice is critical to maintaining an adequate nursing workforce. An increasing body of evidence links healthy PPWEs with improved patient safety and health care worker satisfaction” (Bowles et al., 2019). Nurses feel less empowered to lead, are dissatisfied, and will ultimately leave their jobs when incivility is prevalent in PPWEs.
I do believe the efforts of the quadruple aim in attempting to improve work-life balance by increasing awareness of leadership and making staff satisfaction a priority is helping, but there is still room for improvement. In conclusion, we have to consider who and what we are advocating for. Advocacy as a quality was derived from the subcategories of “need to advocate for,” “calls to action,” and “policy change.”(Bowles et al., 2019). As future practitioners, we must ask ourselves what we are called to change and if we can provide the best care for our patients if we aren’t caring for ourselves first.References
Bowles, J. R., Batcheller, J., Adams, J. M., Zimmermann, D., & Pappas, S. (2019). Nursing’s leadership role in advancing professional practice/work environments as part of the quadruple aim. Nursing Administration Quarterly, 43(2), 157–163. https://doi.org/10.1097/naq.0000000000000342
American Nurses Association. (2015, November 25). Code of ethics for nurses with interpretive statements. Nursing World. https://www.nursingworld.org/
Broome, M. E., & Marshall, E. (2021). Transformational leardership in nursing: from expert clinician to influential leader (3rd ed.). Springer Publishing Company.-
Collapse SubdiscussionIris Cornell Jessica response from the instructor:
Jessica thanks for sharing. How can staff be confident that ethical awareness has been considered in policy development?
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Collapse SubdiscussionJessica Slavin Response #1
Dr. Cornell,
The transformational leader in healthcare must be fluent in current issues and activities related to health policy (Broome & Marshall, 2021, p. 332). Policy fluency allows the leader to provide input and be proactive rather than reactive to measures that affect healthcare organizations. Ethical awareness involves recognizing the ethical implications of all nursing actions and is the first step in moral action (Milliken, 2018). I believe nurses must become involved in policy-making, advancing education would be a good first step in becoming more aware of law and policymakers to get concerns voiced.References
Broome, M. E., & Marshall, E. (2021). Transformational leadership in nursing: from expert clinician to influential leader (3rd ed.). Springer Publishing Company.
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man01
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Collapse SubdiscussionJulie Robinson Hello Jessica and class,
Thank you for your post. I enjoyed reading how every nurse here has gone above and beyond for their patients when we miss out on ourselves. Nurses are responsible for taking the same precautions for their own health and safety as they do for the health and safety of others and society as professionals who assess, intervene, evaluate, protect, promote, advocate, educate, and conduct research (American Nurses Association, 2015). The ultimate goal of persistent recognition of the ethical implications of nursing acts is to produce care that is both in line with the moral obligations of the nursing profession and more consistently respects patient goals and desires (Milliken, 2018). So, saying this, I agree with you that leadership is one strategy to enable nurses to act as moral agents and give patients safe and ethical care to increase their ethical awareness.
References
American Nurses Association. (2015, November 25). Code of ethics for nurses with interpretive statements. Nursing World. https://www.nursingworld.org/Links to an external site.
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man01Links to an external site.
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Collapse SubdiscussionMichele Cleary Response #1
Hi Jessica,
Great post. Your post touches on a topic similar to mine. The ANA listed this as provision #5, but it should be #1. A nurse’s mental and physical well-being is of utmost importance to provide better compassionate care for their patients. The exact duties that we owe to others, we owe to ourselves (ANA, 2015). We work so hard to provide the best possible care for our patient’s mental, physical, emotional, and psychosocial health, but we first must care for ourselves; your expression, you can’t pour from an empty cup, is so true! Many factors can lead to our ethical dilemma, from family to short staffing, bullying, and unsupportive leadership. We must have supportive leadership to promote a healthy work environment (Broome & Marshall, 2021). Robust and supportive leadership can create an environment where all nurses feel supported, even when the situation is not perfect, even when the staffing is short. Nursing leaders must promote a healthy, respectful, and ethical environment for the staff. When there is a healthy work environment, everything flows smoothly, and attitudes are much better.
Thanks for your post.
Michele Cleary
References:
American Nurses Association. (2015, November 25). Code of ethics for nurses with interpretive statements. Nursing World.
https://www.nursingworld.orgLinks to an external site.
Broome, M. E., & Marshall, E. (2021). Transformational leardership in nursing: from expert clinician to influential leader (3rd ed.). Springer
Publishing Company.
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Collapse SubdiscussionDallas Wilcox Week 3 Main Post
How Competing Needs Impact Policy Development
Oftentimes a potential policy can be viewed as positive amongst staff and patients, but the administration then rejects the idea. Why is this? The facility’s needs are considered, and the administration weighs the pros vs. cons of the proposed policy. These competing needs often surround saving the facility money, utilizing fewer resources, and after much deliberation, a policy enactment is declined because of the costs. As Kelly and Porr (2018) explain, “We demonstrate how the use of standardized, efficient, and cost-effective care routinely trumps the professional and ethical mandate of RNs to provide individualized patient-centered care” (para. 3). Throughout proposed policy change, the main topic at the forefront of discussion is often surrounding whether or not it is within the department’s budget. It appears that utilizing a business approach to health care is the new normal, but is it the right option?
How do Competing Needs Impact the Lack of Mental Healthcare
Unfortunately, in America, many insurance plans do not currently cover mental health care, or if the plan does cover it, it is extremely costly. This issue is the underlying issue with policy development surrounding mental health needs. It is too costly for facilities to pay the wages of mental health professionals when they do not receive the reimbursement that other medical services received. Coombs et al. (2021) explain that the lack of mental health care services is most closely associated with affordability issues.
Another competing need that impacts mental health care within America, is the need for more acute care compared to mental health needs. When policymakers are looking at the multitude of issues and deciding how to prioritize, it goes without saying that the more acute medical needs are often addressed first by utilizing all resources. Roberts et al. (1999), states “Rural clinicians find it necessary at times to ration care, to provide care outside of their usual areas of expertise and competence, to deal with patients’ “noncompliance” related to access problems, to respond to complaints about colleagues’ impairments, and to make complex clinical decisions about reproductive, end-of-life, and quality-of-life issues without the benefit of specialists” (Ethics and Rural Mental Healthcare).
Impacts of the Lack of Mental Healthcare and How Can Policy Help?
The most notable impact of the lack of mental health care is the increased rates of suicide. Tang et al. (2022) discussed how many individuals die by means of suicide without ever seeing a mental health provider, receiving a mental health diagnosis, and never receiving any care for mental health needs. Tang et al. (2022) stated, “Due to diversity among people who die by suicide without receiving services, there are likely several avenues for increasing the service use for those experiencing suicidality, including improving access, quality, and delivery of existing services and the development of new support pathways” (Discussion).
Thankfully, within the last couple of presidential elections, mental health and suicide prevention have been at the top of the needs to be addressed. The enactment of policies such as the Suicide Crisis Line number change from a 10-digit phone number to a 3-digit number for easier accessibility, The Saving Lives Through Increased Support for Mental and Behavioral Needs executive order which impacts suicide prevention, opioid crisis, and mental health needs (samhsa.gov, 2022), and the funding provided to increase mental health providers throughout many facilities.
Conclusion
In general, competing financial needs and resources are the biggest impact on enacting policies surrounding mental health. Throughout recent years, these competing needs have lessened but not diminished completely. Thankfully, executive orders are now being enacted to address mental health needs nationally. Although there have been many improvements, it is still a great need nationally and much work needs to be done to fix this issue.
References:
Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021, June 15). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM – population health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214217/
McGuire, T. (2016, June). Behavioral Health Information Technology: From chaos to clarity. Health Affairs. https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.0013
Kelly, P., & Porr, C. (2018, January 31). Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice. OJIN. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
Roberts, L. W., Battaglia, J., Epstein, R. S., Dekleva, K., Wallace, A. E., Willging, C. E., Slovenko, R., Roberts, L. W., Walker, R., & Simon, R. I. (1999, April 1). Frontier ethics: Mental health care needs and ethical dilemmas in rural communities. Psychiatric Services. https://ps.psychiatryonline.org/doi/full/10.1176/ps.50.4.497?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmedLinks to an external site.
Table of contents – substance abuse and mental health services … SAMHSA. (2020, December). https://www.samhsa.gov/sites/default/files/saving-lives-mental-behavioral-health-needs.pdf
Tang, S., Reily, N. M., Arena, A. F., Batterham, P. J., Calear, A. L., Carter, G. L., Mackinnon, A. J., & Christensen, H. (2022, January 18). People who die by suicide without receiving mental health services: A systematic review. Frontiers in public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8804173/
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Collapse SubdiscussionHannah Timmer Response 1
Hi Dallas,
Your topic on mental health continues to interest me; you did a great job highlighting the issue and policies. The fact that most insurance does not cover mental health care is sad and concerning. Most mental health treatments were publicly funded and provided in the 1970s, but today’s service delivery has migrated toward the private sector. As a result, the allocation of healthcare resources in the mental health treatment system is becoming more competitive and less affordable (Cuellar & Haas, 2019). It is disappointing to see how money has played a significant role in healthcare accessibility over the years.
While researching your topic, I came across the leading community-based nonprofit in the country, Mental Health America (MHA), which was established in 1909 with the mission of serving the needs of people with mental illness and advancing general mental health (Mental Health America, 2022). Even though they are popular and have been around for more than one hundred years, they also struggle with policy pushback. Despite the pushback, they have fought for reform and have continued to educate across the country.
The ability of RNs to perform as autonomous professionals in accord with their professional expertise, principles, values, and scope of practice is strongly impacted by working within healthcare organizations where the primary aims are cost containment (Hartrick Doane & Varcoe, 2015). This issue has affected not only patients but also nurses. When we took the oath to be nurses, we promised to do no harm and to be dedicated to our jobs. Never did I think money would determine the level of care, if any care, someone gets, especially when It comes to mental healthcare. As you mentioned, there is much work to be done, but the administrative measures currently being acted on are certainly improving the issue.
Cuellar, A. E., & Haas, D. (2019). Competition and the mental health system. The American journal of psychiatry, 166(3), 278–283. https://doi.org/10.1176/appi.ajp.2008.08091383
Hartrick Doane, G. & Varcoe, C. (2015). How to nurse: Relational inquiry with individuals and families in changing health and health care contexts. Philadelphia, PA: Wolters Kluwer.
Mental Health America. (2022). Public Policy issues. Mental Health America. https://mhanational.org/policy-issues
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Collapse SubdiscussionJessica Jarosky RESPONSE TO Dallas from Jessica J.
Hello Dallas,
Thank you for your very informative post discussing competing needs in mental healthcare. I agree with you that a significant competing need in healthcare is the need for healthcare organizations to create a business and make money. Unfortunately, there are negative impacts when hospitals only think about their financial needs versus the needs of the patients, staff, and available resources, including an adverse effect on patient care, decreased safety of nurses, and lack of retention for all employees. Within the inpatient psychiatric hospital I work for, we conduct daily treatment teams to discuss patients’ status, with a focus of the discussion on discharge plans. Unfortunately, the discharge plan is driven by the patient’s healthcare coverage, not their psychiatric or placement status. Frequently, we have patients not covered by insurance be discharged to shelters before being psychiatrically stable, as the hospital knows they will not be reimbursed for their stay. Even with the expansion of mental health coverage in current policies, coverage is still not equal in treating physical health compared to mental health (Bijal et al., 2019).
Patients must show psychiatric acuity, such as suicidal or homicidal ideation, for many insurance companies to approve the patient’s stay. These insurance companies are not considering the toll a premature discharge or discharge to a shelter could take on a patient. Further, this tends to lead to quicker decompensation by the patient, leading to increased emergency room visits for suicidal ideation or drug abuse. Patients with private health insurance are more likely to have extended hospital stays to find proper placement in the community since the administration is not pushing for discharge as they know they will be financially reimbursed. However, suppose a homeless patient is not covered by insurance. In that case, they will be discharged to a shelter and not allowed to wait in the facility for placement to an adult family home, group home, or treatment facility. I agree with you that mental health policies have improved over the last decade, but they are still insufficient in granting access to mental health care for all (Heboyan et al., 2021). I believe there must be policies implemented to increase funding for incentives to work in mental health, as well as funding for increased community resources and improved insurance plans to meet the needs of mental health patients. Thank you for your insight on the topic!
References
Bijal, A. S., Kumar, C. N., Manjunatha, N., Gowda, M., Basavaraju, V., & Math, S. B. (2019). Health Insurance and Mental Illness. Indian Journal of Psychiatry, 61(10), 791–797. https://doi.org/10.4103/psychiatry.indianjpsychiatry_158_19Links to an external site.
Heboyan, V., Douglas, M. D., McGregor, B., & Benevides, T. W. (2021). Impact of mental health insurance legislation on mental health treatment in a longitudinal sample of adolescents. Medical Care, 59(10), 939–946. https://doi.org/10.1097/mlr.0000000000001619Links to an external site.
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Collapse SubdiscussionKasondra Lewis Module 2 Discussion Peer Response #2
Hello Dallas,
I enjoyed reading your discussion post this week. Like you, I also notice the increasing need for mental healthcare going unnoticed. You mentioned insurance and the failure of policymakers to impact the mental health population. Another competing need that affects mental health is fewer mental health providers. According to Kuehn (2022), the shortage of clinicians in the mental health field makes it nearly impossible for patients to secure an appointment without at least a few months’ wait. In addition to the lack of clinicians in mental health, there is also a lack of mental health nurses. One factor contributing to the shortage of mental health nurses is the number of student nurses interested in pursuing mental health nursing after graduation (Ong et al., 2017). A cross-sectional study in Singapore revealed that only 5.2% of nursing students had a great intention of entering into mental health (Ong et al., 2017). The shortage of clinicians and nurses and the rising need for mental health present a crisis that the healthcare industry should prepare for.
References
Kuehn, B. M. (2022). Clinician Shortage Exacerbates Pandemic-Fueled “Mental Health Crisis.” JAMA, 327(22), 2179. https://doi.org/10.1001/jama.2022.8661
Ong, H. L., Seow, E., Chua, B. Y., Xie, H., Wang, J., Lau, Y. W., Chong, S. A., & Subramaniam, M. (2017). Why is psychiatric nursing not the preferred option for nursing students: A cross-sectional study examining pre-nursing and nursing school factors. Nurse Education Today, 52, 95–102. https://doi.org/10.1016/j.nedt.2017.02.014
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Collapse SubdiscussionJessica Jarosky MAIN POST
Competing Needs
In the psychiatric setting, ethical dilemmas and competing needs are present within our daily practice that directly affect our patient population. With the shortage of mental health providers and resources across the nation, mental health patients are not receiving the quality care they need. However, with the lack of long-term care facilities, community resources, and psychiatric providers, our hands are often tied due to the organization’s financial needs. Financial compensation is a significant competing need in healthcare, preventing policies from being implemented to protect patient and nurse safety. When patients’ insurance coverage ends while hospitalized, the administration presses for them to discharge since they will no longer receive financial compensation for their stay. Often, we discharge patients to shelters, knowing that this disposition is not preparing them for success within the community, posing a significant ethical dilemma. Even though our organization advocates for treating all patients regardless of their ability to pay, patients who aren’t covered by insurance are much more likely to be discharged before being psychiatrically stable if they are not covered by insurance. While policies are needed to support safe discharge and treatment plans for patients, hospital organizations are unwilling to change existing policies due to their need to create business and make money.
Competing Needs in Psychiatric Provider Shortage
Multiple competing needs are contributing to the psychiatric provider shortage. Some examples include the lack of full practice and prescriptive authority nationwide, the lack of accredited residency programs, emotional strain from significant, complex caseloads, demands by the court when caring for involuntary patients, insurance reimbursement issues, lack of community resources to provide continuity of care, and federal regulatory barriers restricting the services advanced registered nurse practitioners (ARNPs) can provide (Schorn et al., 2022).
One of the primary competing needs contributing to the psychiatric provider shortage is the lack of full practice and prescriptive authority for ARNPs. With many states continuing to have restricted or limited practice authority, ARNPs are migrating to states with full practice authority (FPA), causing further shortages in providers, often in rural and underserved communities. Specifically, mental health patients are resorting to psychiatric care from primary care providers, who often don’t have the education to treat severe, complex mental health disorders. This leads to increased emergency room visits for non-urgent care as a last resort to obtain psychiatric medication and increases the cost of care (Bosse et al., 2017). “Requirements such as mandated collaborative practice agreements (CPAs) and physician-supervised transition-to-practice periods increase the cost of providing care, lead to gaps in care, and deter APRNs from working in these restrictive states, without any demonstrated improvement in safety or quality” (Bosse et al., 2017, para. 4). In states with FPA, there have been many proven benefits to patient care outcomes, as well as decreased cost of care, decreased prescriptions leading to overdose deaths, increased comanagement between the interprofessional team, and expanded access to providers within rural and underserved communities (Bosse et al., 2017).
Policy Addressing Competing Needs
In my opinion, I believe one policy that should be introduced to increase practice and prescriptive authority for ARNPs nationwide. This policy would significantly impact the care we provide to patients across all populations and regions. With ARNPs providing care to more rural and underserved populations than physicians, care can be expanded to reach those within mental health provider shortage areas and increase primary care prevention for all. When the Affordable Care Act omitted ARNPs from the list of primary care providers, states were allowed to determine the scope of practice and inhibit ARNPs from being reimbursed for their primary care services (Bosse et al., 2017). Enabling FPA to all ARNPs will significantly decrease the psychiatric provider shortage by allowing providers to work at their full scope of knowledge and expertise, backed by evidence-based practice. Nurses within every profession must participate in health policy to address these national healthcare stressors to see improvement within the workforce. As nurses are often working the frontlines and involved in these stressors every day, they have a unique perspective on strategies to address competing needs within healthcare. All nurses are responsible for fostering, developing, and advocating for improved health policy at the organizational and national levels to support the full scope of practice and evidence-based informed nursing to commit to delivering the highest-quality care to our patients (American Nurses Association, 2015).
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/coe-view-onlyLinks to an external site.
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.
Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a national survey: Ongoing barriers to aprn practice in the United States. Policy, Politics, & Nursing Practice, 23(2), 118–129. https://doi.org/10.1177/15271544221076524Links to an external site.
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Collapse SubdiscussionIris Cornell Jessica J, a response from the instructor.
Jessica, thanks for sharing a good posting. You mentioned a recommendation for policy change to balance the competing needs you mentioned, what might be a way to address the ethical shortcomings of the existing policies?
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Collapse SubdiscussionJessica Jarosky RESPONSE TO Dr. Cornell from Jessica J.
Hello Dr. Cornell,
Thank you for the response. Indeed, there are ethical shortcomings of existing policies inhibiting full practice and prescriptive authority to advanced registered nurse practitioners (ARNPs) that need to be addressed in an effort to broaden the provider workforce. Expanding the scope of practice for nurse practitioners has caused hesitation from ethical dilemmas between physicians and medical organizations as full practice authority has been thought to have contributed to a further nursing shortage, with concerns over ARNPs’ ability to prescribe narcotics safely and lack of physician oversight contributing to adverse effects in patient care. Physicians expressed concern over the lack of education ARNPs have compared to physicians and believed they should not be reimbursed by insurance companies as equal counterparts (Hain & Fleck, 2014). Further primary research must be conducted to determine ARNPs’ ability to provide equally safe, effective, and quality treatment as physicians. Data from states with full practice and prescriptive authority should be utilized when addressing policy-makers to educate physicians and policy-makers on the benefits of ARNPs practicing with their full scope of knowledge and expertise. Bosse et al. (2017) further state that addressing the “lack of consumer awareness of the type and amount of training APRNs receive and the services that they can provide, opposition from professional medical associations, and legislators who are tired from previous legislative attempts to widen APRN scope of practice” (p. 762) can decrease barriers to full practice while increasing primary care options for Americans within all communities. Nurse practitioners must work with nursing organizations and leaders to raise awareness of the scope of training and education of ARNPs. The ethical shortcomings physicians and medical organizations present must be addressed to properly implement policy change and address the competing needs in healthcare. Thank you for the question!
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.
Hain, D., & Fleck, L. (2014). Barriers to NP practice that Impact Healthcare Redesign. OJIN: The Online Journal of Issues in Nursing, 19(2). https://doi.org/10.3912/ojin.vol19no02man02Links to an external site.
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Collapse SubdiscussionDallas Wilcox Week 3 Response #2 to Jessica Jarosky
Jessica, I appreciate your discussion regarding the vast epidemic surrounding a shortage of mental health providers. I also decided to delve further into this issue for my discussion as I see this impact in my daily work. I appreciate your insight on the competing needs and discussion surrounding prescribing authority; that was very educational and opened my eyes to that aspect.
Another competing need I would bring up is the issue surrounding insurance and mental health care coverage. Although there has been a recent focus on mental health and the passing of acts that address mental health, insurance companies are still not providing adequate mental health care coverage. Insurance companies should cover mental health needs as they would physical needs. Oftentimes there are not enough providers that are in-network for these patients, and they are then forced to go outside of the network, which becomes costly, and many patients cannot afford to do so (Bogusz, 2020). This is a vicious cycle of mandating insurance coverage but not enough providers to cover it, starting from square one again. This often poses an ethical component to providers as they must meet patient needs and follow coverage policy. Nurses must be able to support the best interests of the patient but also maintain relationships with colleagues and interprofessional relationships as well (Hegge et al., 2015).
The best way to tackle this issue is to promote and advocate for mental health providers. As you discussed, they are often burnout, not compensated well, and carry complex and troubling caseloads. Miller (2019) suggests legislation be passed surrounding the enforcement of parity laws, funding to increase mental health staff and programs, and decreasing stigma by outreaching communities and programs. If policies were passed that addressed these areas, we could likely see an increase in mental health support and behavioral health care.
Thank you again for a great conversation regarding this critical topic. As we move through this graduate program, I hope to see a change in this field.
References
Bogusz, G. (2020, March 13). Health insurers still don’t adequately cover mental health treatment. NAMI. Retrieved December 13, 2022, from https://www.nami.org/blogs/nami-blog/march-2020/health-insurers-still-don-t-adequately-cover-mental-health-treatmentLinks to an external site.
Hegge, M., Fowler, M., Bjarnason, D., Godfrey, T., Lee, C., Lioce, L., & Ngai, M. (2015). Provisions of the Code of Ethics for Nurses with Interpretive Statements. In Code of ethics for nurses with interpretive statements (pp. 5–6). essay, American Nurses Association. https://www.nursingworld.org/coe-view-onlyLinks to an external site..
Miller, J. (2019, May 28). It’s time to increase access to Behavioral Health Care: AHA News. American Hospital Association | AHA News. Retrieved December 13, 2022, from https://www.aha.org/news/insights-and-analysis/2019-05-28-its-time-increase-access-behavioral-health-care
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Collapse SubdiscussionElin Danelian How Competing Needs Impact the Development of Policy
The development of policies may be influenced by competing requirements, such as patients, the workforce, and resources. The nursing shortage that many organizations are experiencing seems to have numerous implications on quality improvement or indicators, including lower customer service ratings, more work, and lower-quality care provided (Kelly & Porr, 2018). Lack of staff in the organization severely affects an organization’s ability to provide high-quality services. There is a need for more nurses to address the shortage, which raises the demand for resources. This would cause an increase in operational costs for healthcare organizations.
A sufficient nursing staff is needed to meet the demands of the workforce. To maintain the organization’s quality, effective workforce utilization is necessary. Patient safety is negatively impacted when a nurse’s workload is high. Resources are a stock or supply of funds, materials, personnel, and other assets that a person or organization can use to operate efficiently (Broome & Marshall, 2021). Resources are needed to balance competing needs for maintaining and implementing new rules to keep our workforce and improve training. The competing demands in this situation could have an impact on how policy is established. The need to maintain nurse and patient safety and the need to ensure there are enough resources available to serve patients with high-quality care are the competing needs. When there are competing needs, it can be challenging for policymakers to strike a balance between the interests of the different groups.
Specific Competing Needs that May Impact Nursing Shortages
Resources, patient care, and staffing requirements are all impacted by workload. In order to serve the community more effectively and to ensure the safety of patients and the entire workforce, the healthcare organization requires more seasoned and trained nurses. Other competing needs include a healthy work environment, safe staffing, and the need to hire more nurses. High workload has a big effect on nurse satisfaction and how burnt out they become. The turnover rate increases as a result. Efficiency within the organization is impacted by workplace insecurity. It affects the organization’s financial expenses as well. Because adequate training is required before recruiting new employees, whether they are temporary or permanent. The policy could resolve these conflicting needs by securing a reasonable staff-to-patient ratio. An ideal staff-to-patient ratio and improved healthcare outcomes can help organizations increase their nurse staffing. Therefore, the financial cost would not increase for the organization.
What Impacts Are and How Policy Addresses the Competing Needs
Patient and employee needs, as well as an organization’s resources, are affected by nursing shortage. High levels of burnout result in mistakes and poor patient outcomes. High workload has an effect on nurses’ intention to leave the profession as well as their job satisfaction and burnout. High nurse turnover drives up the cost of hiring temporary staff or training new nurses. By maintaining an ideal nurse to patient ratio, a policy could resolve these conflicting demands and enhance nurse staffing in organizations while also enhancing patient care outcomes. For example, the ratio for the unit I work for is 4 patients to 1 nurse, meanwhile a medical surgical floor is 5 patients to 1 nurse. This was followed during the pandemic most days because of the policy that was put into place even though we had a nursing shortage in our organization. A facility’s staffing policy can enhance patient care quality and safety as well as the working circumstances for the nursing staff (Hassmiller & Cozine, 2016).
References
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Hassmiller, S. & Cozine, M. (2016). Addressing The Nurse Shortage to Improve the Quality Of Patient Care. Health Affairs, 25(1), 19-21. https://doi.org/10.1377/hlthaff.25.1.268
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
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Collapse SubdiscussionHannah Timmer Main Post
How competing needs affect policy development
Competing needs in healthcare can look like many different things these days. Today some of these needs are related to the safety of patients, the workload of a provider or nurse, resources throughout an organization, and general workforce need. Regarding policy development, each of these needs can play a significant role as the policy directly relies on the current healthcare needs to create the policy. Policies impact fundamental concerns like healthcare delivery, cost, and privacy. It involves legislators’ laws and policies enacted at the municipal, state, and federal levels (University of St. Augustine, 2021). Combining competing needs and procedures can lead to solutions and fulfilling requirements such as the current nursing shortage.
When addressing the nursing shortage, the administration has many factors to consider, such as the safety of patients provided by nurses, nursing retention, budgets, ethics, and resources. Various factors influence the demand for and supply of registered nurses. In today’s world, we see how a registered nurse’s ability to remain in the field is negatively impacted by the current atmosphere of nursing practice. The supply and demand for nursing services will always fluctuate. However, it is time for nursing and administration to participate in policymaking alongside other decision-makers to understand better the nature of these changes and how to respond to them (American Nurses Association, 2021).
How do Competing Needs Impact the Nursing Shortage
While resources are being depleted, nurses are continually challenged to deliver high-quality nursing care (Kelly & Porr, 2018). For nurses to provide quality, safe care, they need the resources to carry this out. The need for more nurses and the unequal distribution of labor in hospitals have a poor effect on current nurses. They are one individual expected to do the work of three people while providing the utmost care. The nursing shortage has made it impossible for nurses to give the care patients need because there are more patients than nurses and only 12 hours in a shift.
Additionally, the nursing field still struggles with a lack of qualified teachers and excessive turnover (Haddad; et al., 2022). The underlying issue of this need is cost and the organization’s choice not to bring in more nurses because they would be shoveling out more money. Although cost and budget are essential in a healthcare organization, so are the patients and the nurses that bring the money in to support the organization. Cost should not be the deciding factor when it comes to the safety and care of nurses and patients. People’s lives should not depend on an organization’s willingness to spend money on staffing.
The Impact of policy on Nursing Shortage
Implementing new policies often requires that organizations and healthcare workers adopt new clinical behaviors while also altering ingrained ones to ensure everyone is on the same page and following the same book. Regarding the nursing shortage, policy can have a positive effect. Policy impact has started with state action across the country. States have looked at various approaches to attract and keep nurses in response to this widespread shortage. A few specific policy levers are lowering license standards, altering regulations governing the scope of practice, enhancing educational initiatives, and providing financial incentives (Enlund,2022). By implementing those policies, their hospitals were relieved, and nurses were willing to help when there was an incentive, especially a financial incentive. Although this policy may be temporary, there are many opportunities to create long-term policies that eliminate nursing shortages by looking at costs and evaluating what an organization is willing to spend to retain and hire more nurses.
In my current workplace, offering sign-on bonuses has drawn in many nurses, and so have retention bonuses. Just like any other job, nurses want to be compensated for their time and energy invested in an organization and its patients. To reach a lasting solution, ongoing efforts to enhance the working conditions for nurses through financial investment and intervention by states and local organizations are required and well deserved.
References
American Nurses Association. (2021). Nursing Shortage: Not a Simple Problem – No Easy Answers | OJIN: The Online Journal of Issues in Nursing. The Online Journal of Issues in Nursing. https://ojin.nursingworld.org/table-of-contents/volume-6-2001/number-1- January-2001/shortage-problem-answers/Links to an external site.
Enlund, S. (2022). Addressing Nursing Shortages: Options for States. Addressing Nursing Shortages: Options for States. https://www.ncsl.org/research/health/addressing-nursing-shortages-options-for-states.aspxLinks to an external site.
Haddad L, Annamaraju P, Toney-Butler T (2022). Nursing Shortage. Stat Pearls. https://www.ncbi.nlm.nih.gov/books/NBK493175/
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice Links to an external siteLinks to an external site.. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6.doi:10.3912/OJIN.Vol23No01Man06.
University of St. Augustine. (2021). Healthcare Policy: What Is It and Why Is It Important?The University of St. Augustine for Health Sciences. https://www.usa.edu/blog/healthcare-policy/Links to an external site.
(Canvas will not allow me to indent, and when I copy and paste from my word document, it deletes my indentation. I tried to do it manually if it looks a little off )
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Collapse SubdiscussionHannah Timmer Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice Links to an external site.. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
FULL CITATION, THE OTHER ONE GOT CUT OFF
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Collapse SubdiscussionJessica Slavin Response #2
Hannah,
Your post grabbed my attention and was so well written. I believe the highest competing need impacting the nursing shortage is the lack of educators and turnover of staff causing a cost-ineffective endless cycle. The “Great Resignation” of 2020 & 2021 caused volatile changes in the supply and demand in nursing that have caused a new approach to navigating the radically changed workforce (Hansen & Tuttas, 2022). The United States continues to be embroiled in a debate regarding several national healthcare policies including those affecting education for health professionals, scope of practice and roles of various health professionals, and ongoing cost, access, and quality of healthcare (Broome & Marshall, 2021, p. 335). The unfortunate thing about this demand is, most nurses opt out of policy discussions because they feel their voices won’t be heard or taken into consideration.References
Broome, M. E., & Marshall, E. (2021). Transformational leadership in nursing: from expert clinician to influential leader (3rd ed.). Springer Publishing Company.
Hansen, A., & Tuttas, C. (2022). Professional choice 2020-2021. Nurse Leader, 20(2), 145–151. https://doi.org/10.1016/j.mnl.2021.12.018 -
Collapse SubdiscussionPamela Corona Laroya Response #2
Hello Hannah,
Informative post! Thank you. You made a valid point on policy development in terms of healthcare needs. In my workplace, I have heard of sign-on and retention bonuses, a temporary solution for the organization not to lose staff nurses. According to Kagan (2022), when an organization goes through a disruptive period of organizational change, senior executives offer incentives to key employees to persuade them to stay with the company until it becomes stable. Retention bonuses are incentive payments to entice employees into staying with a company (Kagan, 2022). The organization’s leaders must act to help solve retention and nurse shortage issues. The impacts of staffing and provider shortages are the continued stress on the existing staff, who struggle to keep up with their current workload. High-stress levels create burnout, leading to errors and poor patient outcomes. High workload also affects nurse job dissatisfaction, burnout, and nurses’ intent to resign. Financial incentives may be one way to solve the problem, but nurses need to keep in mind that leaders will not quickly release financial incentives. A policy and guidelines are necessary for a safe working environment for all the staff and patients must be a priority. Policies that improve the work environment are also essential to enhancing patient safety, quality patient care, and supporting the well-being of the clinical staff (Schlak et al., 2022). Nurses can provide meaningful input into policy development and the day-to-day management of safety, clinical quality, outcomes, and evaluations (Marshall &Broome 2021). Leaders and nurses must work together to help solve staffing shortages to promote a good patient outcome.
References:
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Schlak, A. E., Rosa, W. E., Rushton, C. H., Poghosyan, L., Root, M. C., & McHugh, M. D. (2022). An expanded institutional- and national-level blueprint to address nurse burnout and moral suffering amid the evolving pandemic. Nursing Management, 53(1), 16–27. https://doi.org/10.1097/01.NUMA.0000805032.15402.b3Links to an external site.
Kagan, J., (2022). Retention bonus: definition and how retention pay works. Investopedia. https://www.investopedia.com/terms/r/retention-bonus.aspLinks to an external site.
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Collapse SubdiscussionJeanne Baleng Okuwobi Module II Discussion.
Competing Needs
Competing needs, such as patients, workforce, and resources, may impact the development of an organization’s policy and procedure because the competing needs should align with the agenda of the policies. The national healthcare issue of nurse shortage is a crisis. It affects the leadership body’s ability to establish and follow the rules in an organization because they have to make do with what they have in their hands. At my current job, no rules or regulations are being respected regarding staffing and adequate nurse-patient ratio. A policy addressing adequate nurse staffing is required to meet the patient and workforce needs while minimizing financial costs for the patient and the organization. Proper staffing and ratio are essential as they ensure efficient delivery of holistic care related to quantity, quality, and cost. Thus, it is difficult for organization leaders to plan and implement policies because they have a daily need for staff to care for patients, avoid closing units, and send patients away. In addition, the lack of workforce and resources can result in negative health outcomes. According to Kelly and Porr, These poor outcomes often occur, especially when “RNs know what is the best care for their patients, yet their professional knowledge about how to meet unique and holistic patient needs is subjugated by organizational policies and processes “(Kelly and Porr, 2018).
National Healthcare Issue
Furthermore, the crisis shortage is already stressing nurses, as they have to deal with unsafe nurse-patient ratios with complex assignment acuity. In addition, in some hospitals, nurses are mandated to work overtime. Twelve hours is already long and tiring, and working an extra shift on top of it all is mentally and physically depleting. According to Kelly and Porr, “RNs are constantly challenged to provide quality nursing care while resources are chipped away, sometimes along with their energy, pride, and ability to provide holistic patient care .” Thus, working 48 hours a week makes matters even worse, which can facilitate nurses to make medical errors, thus compromising patient care outcomes.
Addressing Competing Issues
The leadership body in a healthcare organization should advocate for the nursing shortage and plan and implement policies to come up with solutions to the problems: nursing burnout, aging nurse populations, poor work environment, unsafe nurse-patio ratio, and others. Nursing burnout is a serious concern that can spill over to the quality of care that nurses provide to patients, and it can also affect interprofessional relationships and others. Nurses are exposed to intense pain, physical and mental struggles, and death daily. These more stressful components of the job can get to even the most emotionally stable nurses, which causes many nurses to dislike their profession (What is Nurse Burnout, 2022). Thus, leaders must address these issues by hiring enough staff to meet the need of the organization; we need more nursing assistants at the bedside so that the Nurse can delegate some tasks to the nursing assistant. I believe there should be a policy that allows people to work an eight-hour shift at the bedside instead of the long twelve hours because the aging populations are having difficulty committing to the required long shift; thus, they are forced to resign from the workforce earlier than planned. Work environments must promote a safe environment to foster a healthy workforce and maintain staff. A qualitative study shows that nurses were interviewed about their workplace conditions. Many repeatedly complained about feeling ignored, socio-cultural conditions in society, lack of support by managers, and poor organizational climate (Nouri et al., 2019). Lastly, the unsafe patient ratio phenomenon has worsened since the 2020 Covid-19 pandemic; thus, healthcare leaders have to resolve this problem within their organizations. According to the American Journal of Nursing, The ANA supports nurse-patient ratios to address the current crisis; they feel strongly that these ratios must be set in the workplace by leaders of organizations, not legislators. (Michelle Artz is associate director of the Department of Government Affairs at the ANA.)
References
Kelly, P., Porr, C., (January 31, 2018) “Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 6.
Michelle Artz is associate director of the Department of Government Affairs at the ANA. (n.d.). Setting nurse–patient ratios: Ana Bill calls for : Ajn the American Journal of Nursing. LWW. Available from https://journals.lww.com/ajnonline/Citation/2005/05000/Setting_Nurse_Patient_Ratios__ANA_bill_calls_for.37.aspx
Nouri, A., Sanagoo, A., Jouybari, L., & Taleghani, F. (2019, December 31). Challenges of respect as promoting healthy work environment in nursing: A qualitative study. Journal of education and health promotion. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6967129/
What is Nurse Burnout? NurseJournal. (2022, September 1). Available from https://nursejournal.org/resources/nurse-burnout/
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Collapse SubdiscussionIris Cornell Jeanne response from the instructor
Jeanne thanks for sharing good competing needs and developing policies. On your unit does any of the staff participate in policy development?
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Collapse SubdiscussionJeanne Baleng Okuwobi Response II
Hello Dr. Cornell,
Policymaking is an essential factor in helping solve professional issues. Nurses are at the forefront of caring for individuals, families, and communities; while doing so, they experience all sorts of hardships. Nurses must participate in policymaking/decision-making to help facilitate their work conditions. We are always informed of new rules and policies after establishing them. There are several reasons for the limited nursing participation in decisions/ policies making in their hospitals, “The Lack of awareness, inadequate skills, and little opportunity for involvement, and others; time and resources are further obstacles to the nursing profession’s participation in policies. Additionally, studies show that nurses are not given sufficient support to generate the evidence needed to influence healthcare policy” (Welliver, 2022).
Nurses do not participate in decision-making in the unit where I’m currently employed. I consulted with two full-time staff charge nurses, one from the day shift and one from the night shift; they both denied ever having the privilege to participate in policy/decision-making of the unit. According to Milliken, “Given the complexity of contemporary healthcare environments, nurses must be able to recognize and address ethical issues as they arise” (Milliken, 2018). In the current shortage crisis, there are unethical concerns about approaches utilized in workplace environments, such as unsafe workload, mandatory overtime requirements, and lack of adequate personal protective equipment (PPE). Thus, the best way to address these issues and formulate solutions and appropriate policies will be with the help of nurses experiencing these factors.
Reference
Milliken, A., (January 31, 2018) “Ethical Awareness: What It Is and Why It Matters” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 1.
Welliver, M. (2022, December 5). The nursing profession’s potential impact on policy and politics. American Nurse. Retrieved December 14, 2022, from https://www.myamericannurse.com/nursing-professions-potential-impact-policy-politics/
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Collapse SubdiscussionDinorah Abigail De La Cerda Response # 1 Wk 3
Jeanne,
Thank you for your post. It was very well written and enjoyable to read. Something that really stuck out was that you said many nurses are forced to work overtime. As a new grad working, I did not know that in Texas, where I practice, nurses are exempt from mandatory overtime (Health and Safety Code Title 4, 2009). You are right working more hours in a row means more mistakes you can make. There was a time when I worked 8 days in a row after being pressured by the administration. That was the worst thing I had ever done. I was so tired, and I had been drained of all compassion.
Nursing burnout is no joke. There needs to be more compassion for nurses. Something that nurses can do to cope with the stresses of their job by talking to a therapist or finding hobbies that can relax and distract them from the hectic work week. We as nurses need to prioritize our needs and set boundaries for ourselves because we cannot work at 100% when we have 10% left to give.
References
Health and Safety Code Title 4. Texas Constitution and statutes – home. (2009, September). https://statutes.capitol.texas.gov/Index.aspx
Kapple, T. (2022, November 15). Top tips from nurses on dealing with burnout. NurseJournal. https://nursejournal.org/resources/tips-for-avoiding-nurse-burnout/
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Collapse SubdiscussionFatimah Johnson Competing Needs and the Development of Policy
Healthcare issues often take the backseat to the competing demands of an organization. Registered nurses are repeatedly faced with ethical dilemmas and placed in impossible situations that negatively impact the well-being of themselves, their patients, and other staff members while jeopardizing their nursing licenses. Undermining nurses’ ethical mandate to provide high-quality care causes strain and ethical conflicts (Kelly & Porr, 2018). The safe delivery of care should not be optional. Instead, implementing policies to establish safe and healthy guidelines to prevent human error and poor patient outcomes is essential.
Competing Needs that Interfere with Nursing Shortages
Staying within the organization’s financial budget while demanding patient safety without regard to staffing is a national healthcare issue. Safe and appropriate nurse-to-patient ratios are essential for meeting the demands of high-quality, efficient care. Increased workload mixed with high patient acuity negatively affects the workforce and causes high-stress levels in healthcare providers. Chronic stress leads to burnout which can be eliminated by setting realistic goals and speaking up (Thomas et al., 2019). Realistically, hiring more nurses is crucial for staff and patient safety and should take priority over budgeting.
How Policy Addresses the Competing Needs
Establishing policies to protect healthcare providers and their patients is critical. The American Nurses Association (ANA) advocates for safe staffing and is committed to providing evidence-based policy and practice to transform healthcare delivery (American Nurses Association, 2019). The ANA stands behind The Safe Staffing for Nurse and Patient Safety Act of 2018. This legislation creates and implements unit-specific nurse-to-patient ratio staffing plans (American Nurses Association, 2018). Policies that cautiously set nurse-to-patient ratios will increase safety for all and decrease burnout and turnover rates, ultimately allowing staff retention to prevent further shortages.
Conclusion
In conclusion, organizations must improve how it meets their needs. As patient safety is a top priority, leaders must implement and reinforce policies to achieve this goal. Organizations allowing nurses to work understaffed in unhealthy working conditions while expecting positive patient outcomes is unethical. There must be enforced policies to ensure staff and patient safety.
References
Thomas, C. M., Bantz, D. L., & McIntosh, C. E. (2019). Nurse faculty burnout and strategies to avoid it. https://www.sciencedirect.com/science/article/abs/pii/S1557308718302245Links to an external site.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
American Nurses Association. (2018, February 22). ANA applauds nurse staffing legislation. ANA. https://www.nursingworld.org/news/news-releases/2018/ana-applauds-nurse-staffing-legislation/Links to an external site.
American Nurses Association. (2019, July 11). Nurse staffing. ANA. https://www.nursingworld.org/practice-policy/nurse-staffing/Links to an external site.
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Collapse SubdiscussionFatimah Johnson Dr. Cornell – the first and second paragraph would not allow indentation.
Fatimah Johnson
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Collapse SubdiscussionFatimah Johnson *The first and last paragraphs would not allow indentation. – sorry
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Collapse SubdiscussionPamela Corona Laroya Hello Fatimah,
Great post! Thank you. I agree with your statement that registered nurses are faced with ethical dilemmas and placed in situations that impact the well-being of themselves, their patients, and other staff members while jeopardizing their nursing licenses. In our workplace, we tend to float new nurses to another unit in the hospital due to staffing shortages. ICU nurses have a one-to-two ratio of the patient, but when they are floated on the telemetry or surgical floor, they get five patients. New nurses or employee silence exists when there is widespread reluctance to speak up about critical issues of concern (Kelly & Porr 2018). ICU nurses are also assigned to take action on the floor if there are “code blue” and “rapid response team”—extra assignments on top of the patient in the ICU. Ross (2022) stated that the nursing staff is inadequate, and the nurses do additional jobs. According to American Nurses Association (2015), the obligation of nurses to not only patients but also their coworkers is to follow specific steps to do what is correct and try to be an overall good person. At work, we work as a team, and as team players, nurses accept extra work to help the unit. Policy and guidelines for a rational staffing assignment must be followed so nurses will not think of leaving the bedside. According to Milliken (2018), nurses can use policy to voice their concerns about emerging problems like working with insufficient personnel. Leaders in my facility acknowledge the staffing shortage problem, and I can see that they are working on it, but it takes time to end the shortage. As you said, safe delivery of care should not be optional. I agree that implementing policies to establish safe and healthy guidelines to prevent human error and poor patient outcomes are essential.
References:
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Links to an external site. Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man01Links to an external site.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man06Links to an external site.
Ross, J. (2022). Nursing Shortage Creating Patient Safety Concerns. Journal of PeriAnesthesia Nursing, 37(4), 565–567. https://doi.org/10.1016/j.jopan.2022.05.078Links to an external site.
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Collapse SubdiscussionJared Munoz Main Post Week 3
Developing policies have been affected by the competing needs of nursing shortages. Nurses are expected to follow certain standards to deliver quality of care for our patients. The American Nurses Association (ANA) states nurses are to establish, maintain, and improve the work environment to ensure that patient is safe and receives quality of care (ANA, 2015). It is hard for nurse to uphold this standard of care when there are not enough nurses for the patient demand.
Nurses are the frontline workers in healthcare and with nurses retiring and a decrease in new nurses it has put a strain on current nurses to continue to provide care. Many “healthcare organizations shift from a treat-heal-care model to a more corporate or business paradigm, with emphasis on efficiency and cost outcomes as opposed to patient outcomes” (Grinspun, 2000). This mindset from healthcare organizations is more focused on making money regardless of how they do it and the increased stress it puts on healthcare workers thus leading nurses to look for another job, burnout or quit the profession.
One way to prevent nurse burnout and nurses leaving for better jobs is to create policies ensuring that the nurse/patient ratio is set and will not go beyond expectations and ensuring that nurses are properly paid for their hard work for the stress they deal with on a daily basis. I found that these are the two main factors a nurse has in their decision to stay or move on. By increasing pay for nurses’ hospitals will keep quality nurses and their will be a major influx of new nurses flooding the field. The worst thing to do to a new nurse is to overwhelm them with an insane nurse/patient ratio. This will lead to increase stress, depression and being overwhelmed. By creating policies to be in favor of nurses it will give nurses an opportunity “to provide patients with safe and ethical care (Milliken, 2018).
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements Links to an external site. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Grinspun, D. (2000). Taking care of the bottom line: Shifting paradigms in hospital management. In D. Gustafson (Eds.), Care and consequences: The impact of health care reform (pp. 25-48) Halifax, NS: Fernwood Publishing.
Milliken, A. (2018). Ethical awareness: What it is and why it matters Links to an external site. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.htmlLinks to an external site.
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Collapse SubdiscussionDaniel Russell Wright Jared, very informative and interesting post. I liked your idea of a fixed, never to be exceeded, nurse-patient ratio. Competing needs, including those of patients, the workforce, and resources, may influence how a policy is developed since these requirements should support the agenda a policy is promoting. For instance, a policy addressing sufficient nurse staffing is necessary to satisfy patient and worker requirements while reducing costs. The efficient deployment and use of the workforce is crucial to ensuring the delivery of healthcare services in terms of quantity, quality, and cost, according to Lopez et al. (2015). Lack of or excess clinical personnel may result from ineffective workforce deployment and use. For instance, a surplus of clinical personnel may lead to financial inefficiencies and improper resource allocation while attempting to pass for an acceptable staffing level. Due to a lack of resources to provide the necessary services, there will be a decrease in both the quality and quantity of care provided. Overworked nurses will eventually experience burnout, which will compromise patient safety. Longer wait times due to insufficient staff will result in avoidable patient deaths (Lopez et al., 2015).
Managing the nursing staff workload is one strategy for establishing an optimal balance. This helps strike a balance between the needed resources and those already on hand, preventing additional expenses from under-staffing a unit and reducing employee engagement. Specific conflicting demands that may affect workload as a national healthcare issue include a match between nursing staff and patients’ wants. In order to provide patients with high-quality, safe care and excellent services while ensuring that operational expenses are manageable, organizations are looking into strategies to guarantee a healthy balance between the skill and size of the nursing staff and patient demands (van den Oetelaar et al., 2016). According to van den Oetelaar et al., it is essential for nursing capacity to be ideally matched to patients’ requirements (2016). This may be done by distributing nurses fairly and judiciously throughout units, resulting in an evenly distributed burden manageable for the nursing staff. This demands that the requirements of the nursing staff and those of the patients be well-balanced.
The requirements of patients, workers, and resources of an organization are all impacted by workload. High levels of burnout result in mistakes and poor patient outcomes. High workload affects nurses’ intention to leave the profession, as well as their job satisfaction and feelings of burnout. High nurse turnover drives up the cost of hiring temporary personnel or training new nurses (van den Oetelaar et al., 2016). A policy can balance these competing objectives by guaranteeing an ideal nurse-to-patient ratio while enhancing nurse staffing in organizations and patient care results. The policy may specify a particular nurse-to-patient ratio depending on the kind of unit inside a healthcare facility. For instance, one nurse will be allocated to a maximum of five patients in a surgical and medical unit. In contrast, in an acute unit, the ratio may be 2:1. According to Livanos (2018), establishing a staffing policy in a facility may enhance patient care quality and safety as well as the working circumstances for the nursing staff. In turn, expenditures associated with sticking to the ratios can be compensated by a decrease in the requirement to hire and train temporary or new nurses and a decrease in nursing staff turnover.
References
Livanos, N. (2018). A Broadening Coalition: Patient Safety Enters the Nurse-to-Patient Ratio Debate. Journal of Nursing Regulation, 9(1), 68–70. https://www.sciencedirect.com/science/article/pii/S2155825618300565Links to an external site.
Lopes, M. A., Almeida, A. S., Almada-Lobo, B., & Almeida, Á. S. (2015). Handling healthcare workforce planning with care: where do we stand? Human Resources for Health, 13(1), 38. https://doi.org/10.1186/s12960-015-0028-0Links to an external site.
van den Oetelaar, W. F., van Stel, H. F., van Rhenen, W., Stellato, R. K., & Grolman, W. (2016). Balancing nurses’ workload in hospital wards: study protocol of developing a method to manage workload. BMJ open, 6(11), e012148. https://doi.org/10.1136/bmjopen-2016-012148Links to an external site.
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Collapse SubdiscussionPamela Corona Laroya Week 3-Main Post
How Competing Needs Impact Policy Development
Nurses are to provide quality, safe and effective care to all our patients. Our daily routine and contact with our patients make us understand each patient’s unique needs critical to health, healing, and recovery (Kelly & Porr, 2018). Healthcare workers are bonded with a code that serves as an ethical basis from which nurses can advocate for the delivery of safe, compassionate, competent, ethical care and promote the health and well-being of the individuals (ANA, 2015). Due to staffing shortages, nurses are challenged to do their duties and responsibilities efficiently. Nursing shortages create unsafe conditions for patients; nurses feel that each day to learn to accept this is the way it is, and they feel like they are being “blown off” when they encounter situations deemed unsafe or unethical (Kelly & Porr, 2018). A policy is required to address the competing needs of nurses to ensure a safe nurse-to-patient ratio, improve nurse staffing, prevent bedside errors, improve patient outcomes and regain the confidence and integrity of nurses.
Specific Competing Needs that Interfere with Nurse Shortage
The nursing shortage is a healthcare issue way too long that each nurse gets to adapt and get used to it. Burnout with patient assignments and patient ratio in the healthcare setting may be typical days for some. In my workplace, staffing issues occur when two to three nurses get three patients each, or the charge nurse might get one stable patient. It is challenging for the primary nurse and the charge to care for critically ill patients if we have scarce resources. Leaders try to help with the staffing but not at all times; thus, nurses have to care for three patients for the whole shift. New nurses or employee silence exists when there is widespread reluctance to speak up about critical issues of concern (Kelly & Porr 2018). According to Kelly & Porr (2018), nurses undoubtedly experience frustration, exasperation, and a sense of powerlessness to change circumstances.
How Policy Addresses these Competing Needs
Nurses gladly come to work daily to fulfill their jobs, and unavoidable circumstances may arise, like short staffing and some work errors; however, nurses are protected and covered by policies and organizations. The ANA (American Nurses Association) supports nurses in managing the complexities of modern healthcare and helps nurses deliver excellent care with the existing ethical dilemmas in healthcare reform. If instances arise that the staffing assignment is unsafe and nurses accept the work, they have resources and laws in place to protect the nurse and their license. While dilemmas and challenging situations create the most apparent, dramatic risks to patients, routine actions also affect patients (Milliken, 2018). Patients and family members sometimes get frustrated when we cannot attend to their needs. Inadequate or insufficient nurse staffing levels increase the risk of compromised care, adverse patient events, inferior clinical outcomes, in-patient death in hospitals, and poorer patient care experience (Aiken, 2018). In Texas, nurses can use the safe harbor form in compromised situations like accepting expanded patient assignments and unsafe patient-nurse ratios where it is not in the best interest of patients (Sathasivan, 2020). Nurses can provide meaningful input into policy development and the day-to-day management of safety, clinical quality, outcomes, and evaluations (Marshall &Broome 2021). Policy and laws in the healthcare setting are necessary to build up confidence in nurses and provide safe and quality patient care.
Conclusion
Nurses encounter various challenges, but the support of leaders and good teamwork of nurses can help ease our job. Healthcare organizations must focus on solving the nursing shortage for better patient outcomes.
References:
Aiken, L., Heede, S., et al. (2018) Patient safety, satisfaction, and quality of hospital care: cross-sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ https://doi.org/10.1136/bmj.e1717Links to an external site.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man01Links to an external site.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man06Links to an external site.
Sathasivan, K. (2020). Safe harbor and reliance, what nurses need to know about covid -19.
Texas nurses.org. https://www.texasnurses.org/news/news.asp?id=493894Links to an external site.
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Collapse SubdiscussionFatimah Johnson Pamela,
You make a valid point stating how nurses are accustomed to short staffing and are learning to accept it. At this point, some nurses complain, and some nurses have the “well, there’s nothing I can do about it” attitude. I must admit that I have learned to become numb to the unethical excessive workload and demands. I have learned that no matter how much you complain about unsafe conditions, there is no intervention to rectify this situation other than for organizations to hire more nurses.
Since change is unforeseen, nurses are choosing to master their skills and leave the bedside. Studies show that with increased burnout comes increased intent for nurses to leave their current place of employment (Dyrbye et al., 2019). Deciding to become a nurse practitioner was easy, as I was no longer a fan of burnout or, as you have stated, “powerlessness.” However, increasing nurses’ decisions to become nurse practitioners, thus leaving the bedside, significantly contributes to the bedside shortage (Physicians for Patient Protection, 2021). The situation then becomes a circular problem.
References
Dyrbye, L. N., Shanafelt, T. D., Johnson, P. O., Johnson, L., Satele, D., & West, C. P. (2019). A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses. BMC Nursing, 18(1). https://doi.org/10.1186/s12912-019-0382-7Links to an external site.
Physicians for Patient Protection. (2021, February 26). Nurse practitioner role contributes to bedside nursing shortage – physicians for patient
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Collapse SubdiscussionJared Munoz Response #2
Pamela,
I agree that the nursing shortages is challenging in our duties to “establish, maintain, and improve the work environment to ensure that patient is safe and receives quality of care” (ANA, 2015). As nurses we must adapt to any situation but not at the expense of our own mental health. It is important that we as nurses take care of ourselves as much as we take care of our patients so that we are not burned out. I have found that working in an adolescent unit in a mental health facility can be very challenging and mentally exhausting. When we are full, we have 25 teenagers with all varying mental health issues and only three nurses to provide care including the charge nurse. If I don’t take care of my mental health when I’m at work and especially when I am off, I won’t be able to “provide patients with safe and ethical care (Milliken, 2018). Working with behavioral and suicidal adolescents is extremely challenging but I love my job and my patients which is my main motivator to continue to give all my patients the best quality of care I can give.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements Links to an external site. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Milliken, A. (2018). Ethical awareness: What it is and why it matters Links to an external site. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.htmlLinks to an external site.
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Collapse SubdiscussionOluwashola Adebola Adeniji Main Post
How competing needs may impact the development of a policy
Because they must be compatible with the agenda that the policy is advocating for, competing requirements including those of patients, employees, and resources may have an impact on the formation of policy. It is vital, for instance, to have a strategy that addresses appropriate nurse staffing in order to meet the needs of both patients and workers while also cutting expenses. According to Lopez et al. (2015), guaranteeing efficient delivery of healthcare services in terms of quantity, quality, and cost requires effective utilization and deployment of labor. This is crucial to achieving optimal efficiency.
If the workforce is not deployed and used effectively, the possible outcomes include a shortage or excess of clinical professionals. For example, if there is an excessive number of clinical people, this might lead to economic inefficiency as well as a misallocation of resources, which would be done under the guise of maintaining proper staffing levels. Staff shortages have several negative consequences, including a lower quality and quantity of care due to a lack of resources to provide essential services; work overload among available nurses, which can lead to burnout and eventually compromise patient safety; and longer waiting times due to insufficient staff, which can lead to preventable patient deaths (Lopez et al, 2015).
Specific competing needs that may impact workload
A good match between the requirements of patients and those of nursing staff is one example of the specific competing demands that may affect workload as a national concern in the healthcare industry. In order to offer patients with good and safe treatment as well as remarkable services while keeping operational expenditures affordable, businesses are seeking methods to create a healthy balance between the size and competency of the nursing staff and the needs of patients (van den Oetelaar et al, 2016).
According to van den Oetelaar et al. (2016), the nursing capacity should ideally be matched to the needs of patients. This may be accomplished by a sensible and fair allocation of nurses in units, which results in an equally distributed and manageable load for the nursing staff. This requires striking a delicate balance between the needs of the patients and the available nursing staff. The optimal balance may be achieved in part by properly managing the workload of the nursing staff. This helps to balance required resources with available resources, avoiding excessive expenditures for overstaffing a unit and a reduction in employee engagement or patient experiences caused by understaffing a unit. This also helps to ensure that resources are utilized in the most effective manner possible.
The impacts and how policy might address these competing needs
Workload influences both patient and employee expectations, as well as an organization’s resources. High levels of stress create burnout, which leads to blunders and poor patient outcomes. High workload also affects nurse job dissatisfaction, burnout, and nurses’ intent to resign. High nursing staff turnover increases the cost of employing temporary employees or training new nurses (van den Oetelaar et al, 2016).
A policy might address these competing goals by maintaining an appropriate nurse-to-patient ratio, which can improve nurse staffing in organizations and patient care outcomes. The policy may stipulate a certain nurse-to-patient ratio depending on the kind of unit inside a healthcare facility. In a surgical and medical unit, for example, the ratio may be 5: 1, suggesting that one nurse would be assigned to no more than five patients, but in an intensive care unit, the ratio may be 2:1. According to Livanos (2015), a facility’s staffing policy may improve working conditions for nursing staff as well as the quality and safety of treatment. Therefore, the costs of adhering to the ratios may be offset by a reduced requirement for training new or temporary nurses, as well as decreased nursing staff turnover.
References
Livanos, N. (2018). A Broadening Coalition: Patient Safety Enters the Nurse-To-Patient Ration Debate. Journal of Nursing Regulation, 9(1), 68-70.
Lopes, M., Almeida, A., & Almada-Lobo, B. (2015). Handling healthcare workforce planning with care: where do we stand? Human Resources for Health13:38.
Van den Oetelaar, Van Stel, H., Van Rhenen W, et al. (2016). Balancing nurses’ workload in hospital wards: study protocol of developing a method to manage workload. BMJ Open, 6 (11), e012148.
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Collapse SubdiscussionIris Cornell Oluwashola response from the instructor
Oluwashola thanks for sharing. Has nursing made suggestions to management on these ideas?
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Collapse SubdiscussionFabio Anifrani Response # 1
Oluwashola,
The competing needs of patients, staff, and resources should be compatible with the policy agenda subject for advocacy, as you articulated so well in your discussion post. I also appreciate your comments about how mismanagement of resources leads to economic inefficiencies, including severe staffing shortages. This is one of the reasons why effective leadership is required to confront these challenges and address these competing needs to improve the various healthcare settings (Walden University, LLC [Producer], 2018).
You also made an interesting point about high-stress levels and burnout leading to poor patient outcomes. Consider the projected shortage of registered nurses to spread across the US through the year 2030, with the most significant shortages forecasted to be in the Western region of the U.S. (Jurascthek et al., 2019). Furthermore, the impacts of staffing and provider shortages are the continued stress on the existing staff, who struggle to keep up with their current workload; support your argument for how the increased workload affects nurse job dissatisfaction and burnout, leading to resignations. According to Auerbach et al. (2022), RN staffing levels decreased by more than 100,000 from 2020 to 2021, arguably the most significant drop observed over the last 40 years (Auerbach et al., 2022). The impact of nurses leaving the workforce is essential. It is safe to say that, in this case, the staffing shortages compete with the need to achieve safe patient outcomes.
References:
Auerbach, D., Buerhaus, K., Donelan, O., Staiger, D. (2022). A worrisome drop in the number of young nurses. Health Affairs Forefront, DOI:
10.1377/forefront.20220412.311784
Juraschek, S. P., Zhang, X., Ranganathan, V., & Lin, V. W. (2019). United States Registered Nurse Workforce Report Card and Shortage Forecast. American
journal of medical quality : the official journal of the American College of Medical Quality, 34(5), 473–481.
https://doi.org/10.1177/1062860619873217
Walden University, LLC. (Producer). (2018). Moral Leadership [Video file]. Baltimore, MD:
Author.
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Collapse SubdiscussionDaniel Russell Wright The main concerns an institution should consider while developing a policy are personnel, resources, and patients. These sometimes-opposing requirements have an impact on the overall effect of the policy’s execution. When the proposed policy pertains to nursing staffing and deployment, for example, the institution should consider the number of nurses who are already employed or trained for deployment and the number of nurses necessary to fill any openings. Their backgrounds should also correspond with the place they were given. Furthermore, it is crucial to consider the resources needed to effectively teach and support nurses. Given nurses’ workload, the number of patients should be considered while making nursing staffing decisions (Haddad et el., 2022). For instance, the patient-to-staff ratio on the medical unit at my institution is typically 1:5. Keeping this in mind may decrease nursing errors, and patient satisfaction will increase. The organization’s objective and the ethics of a nurse giving the best patient care possible are only sometimes in harmony with one another (Milliken, 2018). The acuity of a patient can occasionally require a nurse to deliver care in a difficult situation. For example, if during their initial round, nurses allot thirty minutes with each patient, but one of their five patients takes an hour before the nurse can leave the room, nurses, as well as patients, experience dissatisfaction and stress (Haddad et el., 2022). Additionally, it can lead to subpar patient care and results, and it may also be a factor in nurse turnover, which results in the current nursing shortage (Haddad et el., 2022).
When considering the conflicting demands in healthcare, it is essential to remember that nurses are often required to work long hours or extra shifts in addition to their other responsibilities, such as their personal and familial relationships. According to Weiss and Tappen, nurses must juggle their obligations to be nurses, spouses, parents, and occasionally students (2015). Demands inside and outside of nursing may put much strain on one person. The organization’s objective is to hire enough nurses to fill open shifts, which can be difficult. Although hiring new nurses is a continuous process, hospitals usually only hire the bare minimum of staff needed to avoid overpaying by having additional staff available in times of lower need. The nurses are then faced with a difficult choice over how to use their limited time. As a result, more turnover occurs due to higher stress and burnout. How could conflicting needs affect how policies are developed? Conflicting demands or competing requirements may prompt a policy change or the creation of a new policy inside an organization. Policies are the guidelines that direct a practice (Weiss & Tappen, 2015).
The formation of policy might be motivated by conflicting needs. Nurses can use policy to voice their concerns about emerging problems like working with insufficient personnel (Milliken, 2018). The existence of a policy resolves the conflicting demands by defining which needs are more crucial and establishing a hierarchy of importance (Milliken, 2018). This will motivate the management to recruit a replacement or to assume the nurse’s duties until one is found temporarily. The existence of such a policy allows the employees to practice in environments that are fair and safe.
References
Weiss, S. A., & Tappen, R. M. (2015). Essentials of Nursing Leadership and Management (6th ed.). : F.A. Davis Company. https://dl.uswr.ac.ir /bitstream/Hannan/138758/1/9780803636637.pdfLinks to an external site.
Milliken, A., (January 31, 2018) “Ethical Awareness: What It Is and Why It Matters” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 1. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.htmlLinks to an external site.
Haddad, L. M., Annamaraju, P., Toney-Butler, T. J. (2022, February 22). Nursing Shortgae. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK493175/Links to an external site.
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Collapse SubdiscussionNavtej P Singh Hi Daniel,
Very interesting and informative post. I always wondered, why any institution needs a policy related to dictating patient care to influence a unique personal caring relationship between the patient and the nurse. I believe we need to look at the business industry that has cost-cutting successfully by standardizing the actions or processes and finding the best efficient and cost-effective process. If we look at those models like Sigma six, the whole idea is to create a process where the deviation is sigma six. Now sigma is the statistical operator that measures the standard deviation from the mean; if it is at six (6), it allows 3.4 deviations in one million from the mean. If we attempt to reach such a goal, then where is the individualized care that is the hallmark of quality care? Policy and procedures are designed to standardize the process to project cost and thus profits. I understand that we can’t leave it to nurses to do what they want, but the policy shall allow nurses to make decisions based on their professional judgment when necessary.
Whenever there is a conflict between the ethical standards for care and the policy, it is most stressful for nurses. American Nurses Association. (2015) Provision 5 of nursing ethics dictates, “The nurse owes the same duties to self as to others”, but how many times have I been told to prioritize patient safety over mine in a psychiatric ward where I work? The answer is a lot. Metrics has become so important in healthcare that we want to measure everything. Now, quality can’t be measured but can be experienced and may be labeled by hypothetical numbers by patients. The metric is a method or unit of measuring something. Applied to business or industry, a metric is a quantifiable measure used to track and assess a process (Edwards, M. S. (2019). Quality care takes the back seat when all the energy is devoted to improving the metrics because institutions and providers are paid based on metrics, not actual care. I believe this is a major cause of concern for society in general and nurses in particular.
References:
American Nurses Association. (2015). Code of ethics for nurses interpretive statements Links to an external site.Links to an external site.. Silver Spring, MD: Author. Retrieved from
https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Edwards, M. S. (2019). The obsession with metrics in contemporary health care. Journal of Vascular Surgery, 70(3), 665-671.
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Collapse SubdiscussionNavtej P Singh Main Post Module 2
Healthcare is becoming complicated by the day, and the quality of care in the different parts of healthcare is seen improving in isolation. Evidence-Based Practice (EBP) continues to form better practice guidelines for efficient and effective practice across healthcare. Continuous technology and advances in genetics are leading care models toward personalized healthcare. Since the advancement in healthcare, the cost of healthcare has been rising, and it is becoming difficult for the government to afford such expenses, thus mandating healthcare managers to find ways to cut costs. Healthcare administrators looked toward the models used by the industrial revolution. They started to make the healthcare process more and more standardized without paying much attention to the complex needs of the individuals (Kelly, P., Porr, C., (2018).
If we look at quality and reliability, it is essential to standardize the process to find its relationship to the outcome. When the system and the product are standardized, the working efficiency can be determined, and more is expected Antony, J., Palsuk, P., Gupta, S., Mishra, D., & Barach, P. (2018). In healthcare, the final product is a patient experience that is different for every patient depending upon their preferences, values, and beliefs. Standardizing the outcome in a diverse society like the United States is challenging. Thus, it is not the best idea to use the business models used in industrial productions in healthcare.
Nurses enter the field with compassion to serve people. When the conflict arrives between policy and patient care, it creates a moral dilemma of whether to follow the policy or the ethics. The unfortunate part of the situation is that managers and the general population attempt to conclude the action after looking at her results (Kelly, P., Porr, C., (2018). If the nurse’s action causes a bad outcome, it is very straightforward that the nurse may have acted differently, but at the time of action, the results are unknown. Nurses work with the information available to them. Healthcare institutions shall make policies that consider the variability of needs that may be expected of patients within the larger context. Nurses shall be allowed discretion to change practice to best fit the individual patient’s condition.
References
Antony, J., Palsuk, P., Gupta, S., Mishra, D., & Barach, P. (2018). Six Sigma in healthcare: a systematic review of the literature. International Journal of Quality & Reliability Management, 35(5), 1075-1092.
Broome, M. E., & Marshall, E. S. (2020). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.
Kelly, P., Porr, C., (2018) “Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 6.
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Collapse SubdiscussionIvy Dzivenu RESPONSE #2
Hi Navtej,
Great post. I agree with you. Technology can also maintain a connection between patients and healthcare professionals even when they are not in the same room. Rather than “relying on sporadic consultations, it is conceivable, for instance, to create and update a treatment plan on an ongoing basis by utilizing data and technology” (Galen Data, 2022). As we proceeded through the COVID-19 pandemic, clinicians were using telehealth more and more as a critical tool (Pealing et al., 2018). In such hard times, policymakers should consider using such instruments and how they can maintain the healthcare system while ensuring patients continued quality care treatment.
References
Galen Data. (n.d.). The disadvantages of technology in Healthcare – Galen Data. https://www.galendata.com/disadvantages-of-technology-in-healthcare/Links to an external site.
Pealing, L., Tempest, H. V., Howick, J., & Dambha-Miller, H. (2018). Technology: a help or hindrance to empathic healthcare? Journal of the Royal Society of Medicine, 111(11), 390-393. https://bmjopen.bmj.com/content/9/2/e026338.abstractLinks to an external site.
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Collapse SubdiscussionTiffany Johnson Organizational Policies and Practices to Support Healthcare Issues
Healthcare is a forever changing entity. When I began working in healthcare twenty-three years ago, there were sign-on bonuses galore and nurses could get a job in any area they wished without the demand to experience med-surge nursing prior to choosing a specialty. Fast-forward ten years and nurses were struggling to find job right out of nursing school. The sign-on bonuses were gone. The job market was competitive, and the pay was low. Fast-forward another ten years and a pandemic and we are back to a massive nursing shortage, the pay is increasing, and the bonuses are back. However, there is something different this time. The need for more cost-effective care increase as consumers of healthcare and healthcare organizations tried to balance the financial burden of the pandemic. Prior to the pandemic, organizations were already moving toward a business model versus a “treat-heal-care model” (Kelly & Porr, 2018). This is where the stressor I chose to discuss comes to play. The restrictive nature of organizations on the advanced practice nurse.
The biggest challenges facing policymakers in today’s healthcare climate is how to provide good quality and cost-effective health care, and better patient outcomes (Marshall et al., 2015). The issue that nurse practitioners run into to help ease these challenges are made up of old laws and the business focus of healthcare organizations. The patients are getting the brunt of the issues. The current way of health care is quantity not quality (Bauer, 2016). If we (nurse, NP’s, policy makers) can get the right policies in place and get rid of an old school way of thinking, we really make a dent in this healthcare stressor. By allowing NPs to practice as primary care providers, we would see better patient outcomes, many unnecessary costs decrease and better-quality care for patients. I believe the big business of healthcare would also see a profit by being able to accommodate more patients.
References
Bauer, J. (2016). Bundled payment is coming: It is time for nps to get involved. Journal of the American Association of Nurse Practitioners, 28(2), 66–67.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance rn practice. OJIN: The Online Journal of Issues in Nursing, 23(1).
Marshall, D. A., Donald, F., Lacny, S., Reid, K., Bryant-Lukosius, D., Carter, N., Charbonneau-Smith, R., Harbman, P., Kaasalainen, S., Kilpatrick, K., Martin-Misener, R., & DiCenso, A. (2015). Assessing the quality of economic evaluations of clinical nurse specialists and nurse practitioners: A systematic review of cost-effectiveness. NursingPlus Open, 1, 11–17.
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Collapse SubdiscussionIris Cornell Tiffany response from the instructor
Tiffany thanks for sharing. Does your work allow nurses to become involved with policymaking? If so, how?
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Collapse SubdiscussionTiffany Johnson Module 2 Discussion Response 1
Thank you for your question Dr. Cornell.
I absolutely wish there was an avenue to get involved within my organization to work with policy makers on healthcare issues on a national scale. I currently work for one of the largest for-profit organizations in the country. I fear that we would be encouraged to participate more on the business aspects versus patient centered. The problems with getting nurses to get involved in policy making are time and resources. Nurses spend more time down in the trenches of patient care and know what is needed to provide safe and effective care. By not becoming involved at some level in policy making, nurses lose their voices and allow individuals and groups to push their own agenda forward versus what nurses and patients need (Oestberg, 2013).
Nurses do not have to get involved on such a large scale. Many organizations offer clinical ladders, shared governance committees and employee engagement. My organization includes nurses in all three of those arenas. By completing a clinical ladder program, nurses can change current hospital policy based on evidenced-based practice. Once the project in completed and approved by the education and quality departments the nurse if rewarded financially. The shared governance committee is a group of staff members meeting to try and problem solve concerns on their individual units to feel a sense of belonging. Our employee engagement committee is called the EAG. The upper leadership comes together with staff from every unit to hear concerns of the facility and try to find a solution together. I believe nurses want to become involved and when they start at their local level and succeed, they are more apt to work towards policy making on a bigger scale (Wilson et al., 2022). Many studies show that there are happier nurses, and the patient outcomes are better when nurses are “involved, engaged, and empowered to act autonomously” (Bartmess et al., 2022).
One way that I have found to get involved that will help in my future role is by helping to support advanced practice nurses have a multistate license (National Council of State Boards of Nursing, n.d.). To get involved one must fill out a simple form that goes to their state legislation. I look forward to moving on from local policy focus to state and federal.
References
Bartmess, M. P., Myers, C. R., & Thomas, S. P. (2022). Original research: ‘it would be nice to think we could have a voice’: Exploring rn involvement in hospital staffing policymaking. AJN, American Journal of Nursing, 122(10), 22–31.
National Council of State Boards of Nursing (n.d.). Aprn compact. NCSBN. https://www.ncsbn.org/compacts/aprn-compact.pageLinks to an external site.
Oestberg, F. (2013). Getting involved in policy and politics. Nursing Critical Care, 8(3), 48.
Wilson, D. M., Underwood, L., Kim, S., Olukotun, M., & Errasti-Ibarrondo, B. (2022). How and why nurses became involved in politics or political action, and the outcomes or impacts of this involvement. Nursing Outlook, 70(1), 55–63.
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Collapse SubdiscussionMarrisa Montano-White Marrisa Montano-White
December 15, 2022
Module 2 Discussion
Colleague Response 1
Hi Tiffany,
You make a lot of great points about enabling more nurse practitioners to practice as primary care providers. Nurse practitioners (NPs) have a unique background where they can function as nurses and operate as primary care providers. To address the lack of quality healthcare available, nurse practitioners are an excellent resource for patient care needs. According to Norful et al. (2018), the concept of patient care by NPs and physicians helps organize policies to reduce clinician workload and burnout, which then aids in improving patient care, especially for more complicated situations.
Nurse Practitioners are Primary Care Providers
Not all states observe nurse practitioners as primary care providers. According to Phillips (2016), national data has acknowledged that in states that give NPs full practice authority, they gravitate to areas in shortage of primary care providers. NPs not only can aid physicians in serving more patients, but they also can provide a more financially sustainable option for healthcare, being NPs often are less expensive than physicians. More states must consider expanding NPs’ ability to practice as primary care providers to help with physician burnout, fill in care in areas of shortage, and provide more affordable healthcare options for patients.
References
Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse Practitioner-Physician Comanagement: A Theoretical
Model to Alleviate Primary Care Strain. Annals of Family Medicine, 16(3), 250–256. https://doi.org/10.1370/afm.2230Links to an external site.
Phillips, C. (2016). Nurse practitioners wase shortages. Nebraska Nurse, 49(2), 12.
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Collapse SubdiscussionFabio Anifrani Module 2 Initial Post
Considering the many issues plaguing the healthcare community, it is not surprising to have competing needs requiring leadership to prioritize the outcomes to be pursued with more resources dedicated to them. It takes sound judgment and decision-making at the organizational level to meet the needs of the workforce, manage resources, and serve patients. Effective leadership is required to confront these challenges and hold the tensions to make any meaningful impact in the healthcare environment (Walden University, LLC [Producer], 2018). Many healthcare organizations can implement such leadership initiatives by developing policies to guide their operations.
For example, one competing need that may impact staffing and provider shortages is the current trend that many hospitals follow, hoping to achieve magnet status certification. Multiple scientific studies have shown evidence of the connection between adequate registered nurse staffing levels and safe patient care (Harrison et al., 2019). The researchers have found that having a higher proportion of baccalaureate-prepared nurses (BSN) in hospital settings, regardless of their educational pathway, is associated with lower rates of 30-day inpatient surgical mortality(Harrison et al., 2019). The findings support promoting multiple BSN educational pathways (Harrison et al., 2019). However, the reality remains that hospitals still need to work on staffing their beds to accommodate the patient loads they consistently have to welcome into their care. A shortage of registered nurses is projected to spread across the US through 2030 states, with the most significant shortages forecasted to be in the Western US (Juraschek et al., 2019).
The impacts of staffing and provider shortages are the continued stress on the existing staff, who struggle to keep up with their current workload. According to Dr. David Auerbach and colleagues, there is evidence that RN staffing levels decreased by more than 100,000 from 2020 to 2021, arguably the most significant drop observed over the last 40 years (Auerbach et al., 2022). One cannot deny the impact of many nurses leaving the workforce. Many nurses leaving the profession were under 35 years of age, most of whom were employed in hospitals (Auerbach et al., 2022).
A policy might address these competing needs by providing incentives to hire and retain nurses and providers. For example, some organizations offer tuition reimbursement to encourage nurses to stay in exchange for assistance. Another way policy could help address competing needs of staffing shortages and deliver quality. Safe care empowers providers to decide whether or not patient care is appropriate for their current staffing levels. For example, the Minnesota Nurses Association settled a labor contract with hospital leadership involving 15,000 plus nurses and at least five major hospital systems statewide. The contract guaranteed staffing language that provided for nurse input in deciding staffing grid levels to ensure safe patient care and elevate nursing practice throughout the State. Furthermore, this gives nurses a voice to advocate for patients (Minnesota Nurses Association, 2022).
References:
Auerbach, D., Buerhaus, K., Donelan, O., Staiger, D. (2022). A worrisome drop in the number of young nurses. Health Affairs Forefront, DOI:
10.1377/forefront.20220412.311784
Harrison, J. M., Aiken, L. H., Sloane, D. M., BrooksCarthon, J. M., Merchant, R. M., Berg, R. A., McHugh, M. D., & Investigators, R. (2019). In hospitals with
more nurses who have baccalaureate degrees, better outcomes for patients after cardiac arrest. Health affairs (Project Hope), 38(7), 1087.
https://doi.org/10.1377/hlthaff.2018.05064
Juraschek, S. P., Zhang, X., Ranganathan, V., & Lin, V. W. (2019). United States Registered Nurse Workforce Report Card and Shortage Forecast. American journal
of medical quality : the official journal of the American College of Medical Quality, 34(5), 473–481. https://doi.org/10.1177/1062860619873217 Links to an external site.
Minnesota Nurses Association. (2022). 15,000 nurses ratify contracts to address short staffing and retain nurses at the bedside, continue fight to put Patients Before
profits/
Walden University, LLC. (Producer). (2018). Moral Leadership [Video file]. Baltimore, MD:
Author.
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Collapse SubdiscussionIris Cornell Fabio response from the instructor
Fabio thanks for sharing. How can staff be confident that ethical awareness has been considered in policy development?
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Collapse SubdiscussionFabio Anifrani Response #1 to the instructor
Dr. Cornell,
Thanks for this question. It is a fascinating question because much of the outcome depends on leadership. For the staff to be confident that ethical awareness has been considered in policy development, leadership must first communicate to them that it is indeed the case. In addition to communicating it, leaders must ensure that ethical awareness is considered during policy development. Ethical considerations are among the challenges to the opportunities for nurses to participate in policy review actively. Ethical issues can sometimes derail policies and programs, especially in the evaluation phase. The Flint, Michigan, water crisis is an excellent example of an ethical dilemma that faced researchers, advocates, and policymakers. Significant concerns among many stakeholders were ignored, and principles of ethical conduct were violated (Milstead & Short, 2019).
The best way for nurses to overcome these challenges is by being aware of the pitfalls and educating themselves. Nurses can ensure ethical awareness is considered during policy development by educating themselves on the issues that matter to them. Thus, they can be part of the solution and help communicate opportunities to policymakers for further advocacy. Once they acquire the necessary skills to understand the policymaking process, they will be better prepared to participate actively in policy development and review (Oestberg, 2012).
In sum, the best way for staff to be confident that ethical awareness has been considered in policy development is for leadership to involve them in the process. Suppose nursing staff can advocate for what matters to them and participate in the policy design process or shared decision-making. Support for such policies when it comes to implementation will likely succeed. Allowing staff to engage directly with policymaking behind the scenes and taking a front seat in influencing outcomes can be facilitated by democratic leaders within an organization who tend to encourage participation from the team before making decisions. However, transformational leaders can also help to inspire and motivate their teams through effective communication in guiding ethical awareness considerations during policy development (Walden University, LLC [Producer], 2018).
References:
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).
Jones & Bartlett Learning.
Oestberg, F. (2012). Policy and politics. Nursing, 42 (12), 46-49. DOI:
10.1097/01.NURSE.0000422645.29125.87.Bottom of Form
Walden University, LLC. (Producer). (2018). Moral Leadership [Video file]. Baltimore, MD:
Author.
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Collapse SubdiscussionMarrisa Montano-White Marrisa Montano-White
December 17, 2022
Module 2 Discussion
Colleague Response 2
Hello Fabio,
You made many excellent points about the nurse shortages and the importance of BSN-prepared nurses. There has been a more significant push for nursing schools to convert associate degree nursing programs to BSN-level degrees. According to Gerardi et al. (2018), there was an initiative by the Academic Progression in Nursing to create programs to remove obstacles preventing nursing students from getting their BSN which included partnerships for universities and community colleges to help seamlessly transition ADN programs to BSN programs in addition to partnerships between healthcare facilities and schools to create employment opportunities for BSN graduates.
Benefits of BSN Prepared Nurses
Many studies have shown the benefits of BSN-prepared nurses versus ADN-prepared nurses. Rapoza et al. (2022) states that BSN-prepared nurses are associated with improved patient outcomes and decreased morbidity and mortality rates. Improving patient outcomes and decreasing adverse events helps to decrease healthcare costs making having BSN-prepared nurses more cost-effective. It would be beneficial to employ more BSN nurses to maximize patient care. The more we can convert ADN nurses to BSN nurses, the better we can advance patient care. Due to the shortage of nurses, it is crucial to ensure the nurses we have are as strong as they can be to provide the best patient care.
References
Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared workforce goalLinks to an external site.. American Journal of Nursing, 118(2), 43–45.
Rapoza, S., Tucker, K., Campbell, S., & Morris, P. (2022). Improving the local nursing workforce through creation of an RN-BSN program. Teaching & Learning in Nursing, 17(4), 417–420. https://doi.org/10.1016/j.teln.2022.06.011
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Collapse SubdiscussionMarrisa Montano-White Marrisa Montano-White
December 14, 2022
Module 2
Main Discussion Post
Competing Needs and Policy Development
The competing needs of the nursing workforce and the resources available can affect how policies are developed. It has been an ongoing challenge to put a fully staffed nurse workforce with limited resources available. According to Kelly and Porr (2018), healthcare has been reformed over the years to be structured more like a business model due to the realization that the national program services, Medicare, cost too much and are not sustainable. It was mandated by the federal government to improve the quality and efficiency of healthcare services in Medicare by reforming current practices and utilizing resources more efficiently. This is a prime example of how competing needs of patient care are affected by the resources available. In this example, policies were changed to address the lack of financial resources available, causing healthcare to reassess how staffing and patient care could be addressed more efficiently.
Competing Needs of the National Nurse Shortage
The national nurse shortage has posed a more significant challenge in recent years after the COVID-19 pandemic due to increased demand for nurses and a decreased number of nurses in the workforce, causing competing needs. According to Turale and Meechamnan (2022), The World Health Organization has projected a shortage of 5.7 million nurses by 2030, meaning that the government will need to help invest in more nurses to complete nursing school and retain nurses in their positions. Policies and programs will have to be implemented to combat the competing needs of healthcare and the increasing shortage of nurses. Many hospitals are adopting the shared governance policy, which encourages nurses to be involved in decision-making to help make changes as one solution to the nurse shortage crisis. According to Kronig (2019), shared governance is a professional practice model that focuses on partnership, equity, accountability, and ownership that help to form a supportive framework to enable better decisions to improve patient care. It is not feasible to solve the nursing shortage with the available resources; therefore, it is essential to find alternative solutions like this for better workflow and to maximize patient care until more long-term staffing solutions can be determined.
References
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice Links to an external
site.. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from
2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
Kroning, M. (2019). SHARED GOVERNANCE SPOTLIGHT. Healthcare organizations thrive with shared governance. Nursing
Management, 50(5), 13–15. https://doi.org/10.1097/01.NUMA.0000557781.40049.2d
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.
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Collapse SubdiscussionIris Cornell Marissa response from the instructor
Marissa thanks for sharing. What can you do as a nurse to help balance the competing needs while addressing any ethical shortcomings of existing policies?
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Collapse SubdiscussionMleh Porter How Competing Needs May Impact the Development of Policy
The current healthcare of nursing burnout following COVID-19 has impacted the development of policies. Nursing organizations and leaders must balance developing policies to improve nursing healthcare issues, such as nursing burnout and staffing shortage, with competing needs, such as reduced workforce and patient care. It is the nurse’s responsibility to ensure that the practice environment is safe to ensure the safe delivery of patient care. Nurses must speak up to improve their work environment and patient care (Kelly & Porr, 2018). The American Nurses Association (ANA) has provided a foundation for ethical nursing practice. According to provision two, the nurse’s primary commitment is to the patient. Ethically, nurses must advocate for policies that promote and improve their patient’s safety and health outcomes (ANA, 2015).
Competing Needs on National Healthcare Issues Selected
The COVID-19 pandemic brought to light many of the occupational challenges experienced by nurses, such as staffing shortages, poor work environments, and solid ethical frameworks leading to the development of burnout and moral suffering among nurses (Schlak et al., 2022). Unfortunately, a competing need that may impact the issue of burnout is the increased workload and patient care needs in the face of the reduced workforce resulting from high turnover affecting the quality of care and patient outcome. Working in this situation often increases the risk of adverse patient outcomes, job dissatisfaction for the nurses, and moral distress for the nurse. When the integrity of clinicians is threatened due to the inability to do what they believe is morally right, it leads to moral pain (Schlak et al., 2022). According to provision six of the code of ethics, nurses have the moral obligation to maintain a work environment that fosters safe care (ANA, 2015).
How Policy May Address Competing Needs
When healthcare leaders and those in positions to effect policies fail to create a working environment that promotes the safe delivery of patient care, they prevent nurses from providing patient care with clinical skill and ethical standards leading to moral conflicts and contributing to nurses’ burnout (Schlak et al., 2022). Burnouts among the clinical team can negatively impact patient care quality, lead to medical errors, which could result in death, and cost the healthcare system millions in turnover (The Ohio State University, n.d.). To prevent burnout, policies must be created to address competing needs, such as increased nursing shortages and workload. National policies should be implemented to mandate staffing ratios which will help improve safety and patient care. The staffing mandate protects nurses and their patients by preventing unsafe assignments. Hospitals must follow the minimum staffing ratio and can increase staffing needs based on acuity. For example, California mandated a staffing ratio of no more than five patients to one nurse on medical-surgical units in 2004. As a result, hospitals in California have reported improved staffing (Schlak et al., 2022). In addition, policies that improve the work environment are also essential to enhancing patient safety, quality patient care, and supporting the well-being of the clinical staff (Schlak et al., 2022). Improving the work environment and addressing the increased workload.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretative statements. https://www.nursingworld.org/coe-view-only
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN Practice. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/ojin.vol23no01man06
Schlak, A. E., Rosa, W. E., Rushton, C. H., Poghosyan, L., Root, M. C., & McHugh, M. D. (2022). An expanded institutional- and national-level blueprint to address nurse burnout and moral suffering amid the evolving pandemic. Nursing Management, 53(1), 16–27. https://doi.org/10.1097/01.NUMA.0000805032.15402.b3Links to an external site.
The Ohio State University College of Nursing. (n.d.). New policy brief urges action to address burnout in healthcare professionals. https://nursing.osu.edu/hpio-policy-brief
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Collapse SubdiscussionFabio Anifrani Response #2
Mleh,
Thanks for your discussion post. It is interesting how much work it takes for nursing organizations and leaders to balance policy-making and improve conditions at the bedside to avoid nursing burnout and staffing shortages. I appreciate your comments that it competes with the needs of patient care. Much is indeed expected from the nurses. However, I don’t believe the responsibility to ensure that the practice environment is safe to ensure the safe delivery of patient care solely belongs to the nurses. There is evidence of nurses speaking up everywhere and demanding better conditions to improve their work environment and patient care. For example, the Minnesota Nurses Association settled a labor contract with hospital leadership to guarantee that staffing involves nursing input in deciding staffing grid levels to ensure safe patient care and elevate nursing practice throughout the State, thus giving nurses a more prominent voice to advocate for patients (Minnesota Nurses Association, 2022).
I also appreciate your comments about how increased workload and patient care needs are competing needs that may impact burnout the in the face of the reduced workforce resulting from high turnover affecting the quality of care and patient. Considering the many issues plaguing the healthcare community, it is not surprising to have such problems come up from time to time and time. Effective leadership is required to confront these challenges (Walden University, LLC [Producer], 2018).
References:
Minnesota Nurses Association. (2022). 15,000 nurses ratify contracts to address short staffing and retain nurses at the bedside, continue the fight to put
Patients Before Profits. https://mnnurses.org/15000-nurses-ratify-contracts-to-address-short-staffing-and-retain-nurses-at-the-bedside-continue-fight-to-put-patients-before-profits/
Walden University, LLC. (Producer). (2018). Moral Leadership [Video file]. Baltimore, MD:
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