Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

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10 Things Nurses Learn Outside of the Classroom

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.


Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.


To Prepare:

  • Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
  • Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.


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.


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.


Main Post

A policy is a written detail of the hospital staff’s rules. Policies and procedures allow everyone, no matter their level of education, to follow the same steps to ensure appropriate and safe patient care. Regarding competing needs, if we can work on having a good balance between nursing shortage and patient demands, we can improve the health of the patient and the nursing staff at the same time. 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. As nurses, we give up many things to provide the best care for our patients. We miss our family, lunch, and even bathroom breaks to provide fantastic care for these individuals while they are under our eye.

Twigg et al. (2010) spoke about how even more than ten years ago, there was going to be a shortage of nurses in upwards of 60,000 just in Australia. Turale and Meechamnan (2022) stated that there is now over a 5 million shortage of nurses globally. One policy specific to nursing staffing should include the nurse-to-patient ratio to allow for the appropriate implementation of care safely. Unfortunately, if the number of nurses is at an all-time low, the lousy patient outcomes could be at an all-time high.

The steady workload within the nursing world pushes nurses beyond their means and can lead to patient care errors. According to Walden University (2012), one specific outcome of nursing shortages is that more patients are released earlier than they should and expected to take care of themselves instead of being transferred to a rehab or skilled nursing facility. Ross (2022) stated that the nursing staff is inadequate, and the nurses are asked to do extra jobs. The increasing number of unnecessary patient errors and unable to be good hall buddies to the other staff on the unit is one way this shortage affects both the patients and the nursing staff. Hospital administrators expect the team to follow the policies they have written. Still, it is downright out of reach, and no changes to policies have been implemented to consider the staffing shortages. Policies need to be changed to show how to manage patient care safely during this period of staffing shortages.

Expanded and Paraphrased Post

A policy serves as a written documentation of the established rules and regulations within a healthcare facility. It provides a standardized framework for all members of the healthcare team, regardless of their educational background, to adhere to, ensuring the delivery of appropriate and safe patient care. In the context of addressing competing needs, achieving a delicate equilibrium between the shortage of nursing staff and the demands of patients could result in the simultaneous enhancement of both patient well-being and the job satisfaction of nursing professionals. As per the American Nurses Association (ANA) (2015), nurses bear an ethical responsibility not only to their patients but also to their colleagues, necessitating adherence to specific protocols in the pursuit of correctness and a holistic ethical approach. Nurses often make significant sacrifices to deliver optimal care to their patients, including sacrificing personal time with family, meal breaks, and even restroom visits, all in the service of providing exceptional care to those under their care.

Twigg et al. (2010) discussed the nursing workforce crisis over a decade ago, warning of an impending shortage of nurses exceeding 60,000 in Australia. Alarmingly, Turale and Meechamnan (2022) have reported that the global deficit of nurses has now surpassed a staggering 5 million. A crucial policy related to nursing staffing must encompass nurse-to-patient ratios to facilitate the safe and effective delivery of care. Regrettably, if the number of available nurses remains at an all-time low, the likelihood of suboptimal patient outcomes reaching unprecedented levels becomes a grim reality.

The relentless workload endured by nursing professionals pushes them to their limits, potentially leading to errors in patient care. According to Walden University (2012), one specific consequence of nursing shortages is the premature discharge of patients who may not be adequately prepared to care for themselves, as they are expected to do when they should ideally be transferred to a rehabilitation or skilled nursing facility. Ross (2022) underscores the inadequacy of nursing staff and the additional responsibilities imposed upon nurses. The escalating occurrence of avoidable patient errors and the strain on building positive relationships with colleagues in the unit is one manifestation of how this shortage affects both patients and nursing professionals. While hospital administrators anticipate that their teams will adhere to the existing policies, it is increasingly evident that these policies are unattainable, given the critical staffing shortages. Therefore, it becomes imperative to revise and adapt policies to provide clear guidance on how to manage patient care safely during these periods of severe staffing deficits.


American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from to an external site.

Ross, J. (2022). Nursing Shortage Creating Patient Safety Concerns. Journal of PeriAnesthesia Nursing37(4), 565–567. 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 Review34(3), 312–316. 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 Research26(3), 371–375.

Walden University, LLC. (Producer). (2012). Ethical, Moral, and Legal Leadership [Video file]. Baltimore, MD: Author.



Exploring the Impact of Competing Needs on Policy Development

The nursing profession grapples with a pervasive shortage of nurses, and this scarcity has significantly influenced the development of policies. The American Nurses Association (ANA) has responded by establishing a comprehensive code of ethics to provide guidance to nurses, accompanied by interpretive statements to facilitate understanding (ANA, 2015). In particular, Provision Six within this code emphasizes the responsibility of nurses, either individually or collectively, to assess the ethical aspects of care delivery and its quality (ANA, 2015). This translates into a commitment to uphold ethical standards in care provision, encompassing the safe delivery of care, adequate staffing levels, and the articulation of concerns when ethical care is compromised or improvement is necessary. Furthermore, Provision Two underscores the paramount importance of the patient’s well-being (ANA, 2015), while Provision Seven highlights nurses’ obligation to advocate for the patient’s best interests, even in the realm of policymaking (ANA, 2015).

The Nursing Shortage and Its Confluence with Competing Needs

Nursing stands as the most extensive group within the realm of healthcare professionals (Haddad et al., 2022). Various factors contribute to the overall cost of nursing, including aspects such as training, recruitment, overtime, and staff retention. Among these multifaceted considerations, one of the most prominent competing needs revolves around the financial implications of recruiting and sustaining a robust nursing workforce. Predicting staffing requirements proves to be a complex challenge, further exacerbated by the influences of patient acuity and economic fluctuations (Parsons, 2019). While it may be tempting to reduce costs through lower staffing ratios, this approach often leads to increased instances of overtime, elevated error rates, and potential dissatisfaction among nursing staff (Haddad et al., 2022). Notably, the utilization of agency nurses represents a costlier alternative when compared to traditionally employed nursing staff. Integrating nurses’ perspectives into the framework of safe staffing and ethical care practices holds the potential to enhance nursing satisfaction, even within the context of stringent cost containment measures (Kelly & Poor, 2018). In summary, one of the prominent competing needs is the imperative of adhering to financial constraints and reducing overall medical costs.

Policies Enacted to Address Competing Needs

California, through the enactment of Bill 394, initiated the establishment of mandatory staffing ratios, and several other states have followed suit with similar legislative efforts (Tevington, 2011). Furthermore, several states have introduced laws mandating the publication of staffing ratios (Davidson, 2022). However, it is essential to note that the laws associated with mandatory staffing ratios often fail to consider the nuanced factors of a nurse’s experience, knowledge, education, and patient acuity, and these mandates have yet to be conclusively validated by extensive research (Tevington, 2011). Even in the absence of statutory requirements regarding staffing ratios, numerous studies have consistently demonstrated that an increased ratio of registered nurses (RNs) results in improved patient outcomes, enhanced care quality, and reduced staff turnover rates (Tevington, 2011). The Registered Nurse Safe Staffing Act of 2015 underscores the importance of hospitals providing safe staffing levels and establishing committees that include nurses, thereby affording nursing professionals a platform to advocate for quality care and the ethical delivery of healthcare, in alignment with the principles outlined in Provision 6 and Provision 7 of the ANA’s Code of Ethics (Congress, 2016). These committees play a pivotal role in ensuring that nurses’ voices are heard in shaping policies that promote ethical care delivery and the overall well-being of patients.

In summary, the nursing profession grapples with the ongoing challenge of a nursing shortage, and the competing needs of providing high-quality care while managing costs have necessitated the development of policies and legislative efforts to strike a balance and prioritize ethical care delivery.

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. to an external site. 

Congress. (2016). Summary: S. 1132-114th Congress (2015-2016). 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. to an external site. 

Haddad LM, Annamaraju P, Toney-Butler TJ. (2022). Nursing Shortage. Stat Pearls 

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 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.  

Tevington, P. (2011). Professional Issues. Mandatory Nurse-Patient Ratios. MEDSURG Nursing20(5), 265–268. 

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