Problem Statement
During my practice in the cardiac care unit of 20- bed hospital, I witnessed that most nurses were stressed due to overtime and work- pressure as the ratio of patient to nurse for patient care delivery was 4:1. Such ratios exert huge pressure on the nurse as he/ she has to be attentive to each of her patient as and when needed. Additionally, cardiac care unit’s demands nurses to be highly attentive as most patients admitted need frequent help due to their critical condition. Such situations in which nurses have to handle so many patients’ single- handed increases stress among them. Due to such continuing situation, during my practice, I witnessed one nurse quitting her services while the other went into depression. The other nurses were highly unsatisfied with their job and had lost balance between their personal and professional life. Upon critically analyzing the situation, it was visible that it was the low nursing staffing and high patient- to- nurse ratio that was responsible for the nursing burnouts, ineffective teamwork, job dissatisfaction, low nurse turnover, poor nursing leadership and stressful working environment. Each of these factors also contributed to poor care delivery. Some research has also indicated that it can also result in poor patient outcomes such as shock, pneumonia, SSIs, and cardiac arrest (Marianna, 2010, para. 19). This issue is not limited to the organization I work in but the story is same for every organization and is a growing concern as the number of nursing staff as well as enrolments for the nursing courses by the new generation in different universities is also decreasing. Thus, it is essential to figure out a way in which such scenarios can be prevented.
Patient outcome is an important component of care delivery process as it influences several aspects of their hospitalization such as lesser adverse events, early discharge, increased job satisfaction, lesser nurse burnout and improved care delivery. Thus, in order to improve the patient outcomes and minimize the adverse events different organization has taken different steps. These strategies included improving nursing education, encouraging students to join the baccalaureate programs, increasing wages, giving rewards, etc. However, despite their enormous efforts to restore the staffing levels, the problem still exists. Nurses still are in dilemma when fulfilling the most imperative aim of the organization, which is commitment towards the culture of patient safety and proving the best possible care. Irrespective of repeated efforts, the working environment and the workload of the staff could be minimized. A number of studies have been conducted to assess the relationship between the low staffing levels and patient adverse outcomes, which has given an insight on the various factors that are highly influencing these two factors i.e., nursing shortage and patient adverse outcomes (Shekelle, 2013, para. 20). However, even with the in- depth knowledge of the factors that influences these two issues, the actual problem still remains unsolved. The problem of reducing workload, stress, job burnouts, job dissatisfaction and improvement of the working condition still remains unsolved. The deficit of proper work environment for the nurses is the major factor that is leading to the reduction in nursing rate in every organization, which needs immediate solution.
Nursing shortage due to excessive workload is a common and major concern in every healthcare organization today. Research have indicated that the major factors behind this growing concern are increase in demand for nurses, nursing shortage, increased overtime, ageing of both patients and qualified nurses and increase in the duration of hospital stay. The ageing population has been estimated to grow further by 54 %, while the increase in nursing staff is expected to be only 6% by the end of 2020 (U.S. Department of Labor, Bureau of Labor Statistics, 2013, para 3). This is leading to increase in number of above 65 patient populations with increasing healthcare needs, and decrease in number of qualified nurses to meet the needs of the patients. Therefore, nursing shortage is a major issue as with growing time, the retention of nurses is also becoming difficult due to high- stress environment and excessive work pressure. The impact of this growing concern is not only affecting the nursing staffing levels or the workforce but is also affecting the patient outcomes as a result of increasing adverse events due to poor care delivery and in some cases adverse events such as medication errors. Therefore, it can be stated that the growing concern is not limited to low nursing staffing levels and patient adverse outcomes but is also hugely affects the healthcare organization’s reputation and standards (Shekelle, 2013, pare 21). In order to achieve optimal nurse staffing levels in every organization, it is essential to first recognize different units, patient care settings, patient’s health condition, available of extra resources and help, educational training and workload in different shifts. The nursing shortage is the primary cause of all the problems as it leads to the consequences of job burnouts, job dissatisfaction, overtime, excessive workload, stress, poor working environment, poor team- work, etc. Thus, it is essential first solve the issue of nursing shortage as this might help in solving other issues efficiently. A poor working environment can hugely influence the patient ad nursing outcomes and thereby also affect the reputation and standard of care delivery of a health care organization .
The low nursing staffing levels are associated with a number of factors. Advancement in the medical field has led to introduction of new technologies. Most nurses’ are unable to adjust with the technology and thus it acts as a stressor to them. Other factors such as low accountability, poor team work and collaboration among the health care professionals and little or no support from the management also hugely impacts the nursing staffing levels and thereby the quality care process. Low staff levels can result in excessive workload, which in turn forces the nurses to work overtime to meet the client’s needs. This destroys the balance between the personal and professional lives of the nurses. Therefore, the factors affecting the staffing levels and patient outcomes pose huge impact on the mental and physical health and well- being of the nurses .
Hence, there is an urgent need for the development of an effective intervention to prevent adverse events among the patient population as a result of low nursing staffing levels. The possible effective intervention would be supporting the existing nurses by providing them with counselling services, rewards for better performance, yoga/ medication sessions to reduce stress, trainings and higher studies opportunities with a reduced cost or full scholarship. Furthermore, introducing the nursing staff to new technology and educating them can help in minimizing their work load and stress, which in turn can increase their efficiency. This intervention is expected to work because this will help to reduce the stress among the existing nurses and also bribe them to perform better for becoming more qualified and gain better positions. The intervention is also expected to increase the sense of accountability and team work skills in nurses, which would further aid them in improving the patient outcomes and minimize medication errors and thereby solve the issue of nursing shortage.
References
Marianna, V. (2010). Overtime work and incident coronary heart disease: the Whitehall II prospective cohort study. European Heart Journal.
Shekelle, P. (2013). Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville: Agency for Healthcare Research and Quality (US).
U.S. Department of Labor, Bureau of Labor Statistics. (2013). Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work. Retrieved from Bls: http://www.bls.gov/news.release/pdf/osh2.pdf
