Question

Discuss in detail the healthcare staffing issues in the US and how it is an increasing problem. Please explain in detail how nurses are particularly affected by it.

Answer 1

The subject of nurse-patient ratios comes up often in nursing circles, and can often be a topic of discussion in state legislatures around the United States. Ratios are also a topic of conversation and disagreement in other countries( Carlson,2017)Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes. Twenty-four hour nursing care is one of the distinctive hallmarks of inpatient care in hospitals. Historically, hospitals have been at the core of the U.S. health care system, and nursing services are central to the provision of hospital care. They have also functioned as the traditional place of work for nursing personnel and especially for registered nurses (RN). Nursing personnel comprise the largest proportion of patient care givers in a hospital. Nursing care in hospitals takes on added importance today because increase in acuity of patients requires intensive nursing care.(Wunderlich et.al 1996).

The current and predicted future shortage of nurses is also problematic. Dr. Peter Buerhaus, the Valere Potter Distinguished Professor of Nursing and Director of the Center for Interdisciplinary Health Workforce Studies, the Institute for Medicine and Public Health, Vanderbilt University Medical Center, reported that there is an ongoing shortage of nurses that began in 1998. This is the longest lasting shortage of nurses in over half a century, and was sparked by a lack of supply (i.e., too few nurses entering the workforce) rather than by an increasing demand for nursing services. In 2002, the vacancy rates for nursing positions were as high as 13 percent, and currently are estimated to be roughly 8 percent or lower (AHA, 2007; Buerhaus et al., 2009).

The value of such clinical nurse specialists, in terms of both patient care and economic factors have been studied over the past 20 to 25 year. The redesign of nursing services also is leading to changes in the roles and responsibilities of RNs and to increased emphasis on interdisciplinary teams. These developments have prompted uncertainty in employment and great concern among RNs about the potential for erosion of quality of hospital care, and about their own well-being.(3)

“Inadequate nurse staffing levels by experienced RNs are linked to higher rates of patient falls, infections, medication errors and even death. As a result of massive reductions in nursing budgets, combined with the challenges presented by a growing nursing shortage, fewer nurses work longer hours and care for sicker patients. This situation compromises care and contributes to the nursing shortage by creating an environment that drives nurses from the bedside.

“ANA and its Constituent & State Nurses Associations (C/SNAs) in the states are promoting legislation to hold hospitals accountable for the development and implementation of valid, reliable, unit-by-unit nurse staffing plans. These staffing plans, based upon ANA's Principles for Nurse Staffing (member login required), are not mandated ratios. They are created in coordination with direct care registered nurses (RNs) themselves, and based on each unit’s unique circumstances and changing needs.”(1)

While none of us have a crystal ball and predicting staffing shortages is never an exact science, it’s safe to say healthcare systems will benefit by becoming more proactive rather than reactive in terms of staffing. Above all, we must remember we have an ethical responsibility to ensure any staffing challenges do not compromise patient care, or unduly burden existing staff.

• Flexible scheduling. This is currently the top reason nurses leave their organization in the first year. The scheduling process requires clinicians to sign up for shifts eight weeks in advance, and there is very little flexibility to adjust the schedule once it is complete. The process for scheduling is cumbersome and relies heavily on a manual process. And certainly isn’t accommodating to any spontaneous weekend getaways.
• Candidate pipelines. This is basic supply and demand — there are more job openings than there are graduates. Healthcare organizations need to be future-focused in workforce planning and have stronger connections with high schools, colleges, and training centers to recruit future healthcare workers.
• High tech. Healthcare has been slow to adopt the use of technology for both recruitment and scheduling. We have a lot to learn from other industries like Uber, Google and AirBnB, which will also help us attract younger, more tech savvy workers.
• Timely orientation. Currently it takes at least 12 weeks to orient a new nurse before he or she can work independently, but this isn’t always necessary. Education and onboarding doesn’t need to be a “one size fits all” approach.
• Cross training. Nurses and other clinicians tend to specialize, but with additional training and development, nurses could fill shifts in other departments and settings. Often tenure in a department is a factor in scheduling, but that model leads to nurses specializing in one area and limits cross training. Tenure might not be the best determination for scheduling.(4)

Here are five big issues facing nurses today.

1. Compensation. When it comes to nurse compensation, regional differences are to be expected based on cost of living.

Nurses living in certain regions of the U.S. make much more than nurses in other regions, according to the Association of periOperative Registered Nurses organization.

2. Workplace violence. Another major challenge nurses face is violent behavior while on the job, be it from patients or coworkers.Between 2012 and 2014, workplace violence injury rates increased for all healthcare job classifications and nearly doubled for nurse assistants and nurses, according to data from the Occupational Health Safety Network. A total of 112 U.S. facilities in 19 states reported 10,680 Occupational Safety and Health Administration-recordable injuries occurring from January 1, 2012, to September 30, 2014. There were 4,674 patient handling and movement injuries; 3,972 slips, trips and falls; and 2,034 workplace violence injuries.

3. Short staffing. Staffing is an issue of both professional and personal concern for nurses today. In fact, issues related to staffing levels, unit organization or inequitable assignments are one of the top reasons nurses leave a hospital job.If staffing is inadequate, nurses contend it threatens patient health and safety, results in greater complexity of care, and impacts their health and safety by increasing fatigue and rate of injury.

4. Long working hours. Nurses are often required to work long shifts. But in a number of cases, nurses must work back-to-back or extended shifts, risking fatigue that could result in medical mistakes.

5. Workplace hazards. Nurses face a number of workplace hazards each day while just doing their jobs. These hazards include exposure to bloodborne pathogens, injuries, hand washing-related dermatitis and cold and flu germs.(Gooch,2015)

ref:

1. Keith Carlson,nov 1 2017,Nurse-Patient Ratios and Safe Staffing: 10 Ways Nurses Can Lead The Change.nurse.org

2.Peter I. Buerhaus, David I. Auerbach, and Douglas O. Staiger,2009,The Recent Surge In Nurse Employment: Causes And Implications.The Future of the Nursing Workforce.

3.Wunderlich GS,Sloan F, Davis CK,1996,5 Staffing and Quality of Care in Hospitals .Institute of Medicine (US) Committee on the Adequacy of Nursing Staff in Hospitals and Nursing Homes,Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?.

4.Intermountain Healthcare,2017,Finding a Cure for Healthcare's Staffing Shortage.

5.Kelly Gooch ,August 13, 2015,5 of the biggest issues nurses face today,Becker's hospital review,Becker's Healthcare.