Introduction
Staffing issues in nursing that occur because of the growing shortage of nurses and huge budget cuts has been an ongoing concern for a long period (American Nursing Association, 2013). Registered nurses have acknowledged that the issue has led to longer working hours for nurses as they take care of sick patients. The situation puts both the safety of patient and nurses at risk. This has brought the need for adequate staffing levels to achieve the optimal nurse to patient ration that is now a national priority. The projected outcome of safe staffing include; reduced medication errors, a decrease in patients’ complications and mortality rates, reduced nurse fatigue and burnout, improved patient satisfaction and nurse retention.
The American Nursing Association Position on Safe Staffing
The American Nursing Association suggests the solution to staffing issues is holding health care facilities responsible for the creation and execution of reliable and valid safe staffing methods for nurses. The plans are based on the on the ANA’s principles for nurse staffing that identify the primary elements necessary to achieve optimal staffing (American Nursing Association, 2016). The principles do not deal with the nurse to patient ratio rather propose the working directly with registered nurses to develop a plan based on each unit’s different circumstances and changing requirements.
ANA promotes the Registered Nurse Safe Staffing Act that requires health care providers to establish and report staffing plans for every unit through a board. More than half of the board members should be direct care nurses. The direct care nurses must input their views in the staffing plans. The developed approach should state the minimum number of required nurse for every unit considering the skills and expertise of the registered nurses. Other factors that should be taken into account include; other personnel in the medical field who interact with nurses, factors affecting care delivery like geography and technology availability, the individual unit staffing quality and impacts on patient data compared to other national information available. The plan should be based on the number of patients and the varying intensity of required care for each patient. Also, the plan should ensure that registered nurses are placed in units that they are experienced and trained on. Registered nurses should not perform duties that they are not specialized in.
Some measures are in place to ensure every hospital complies with the Registered Nurses Staffing Act. The Act holds hospitals accountable and establishes the process for receiving complaints and conducting investigations. Registered nurses who are whistleblowers and other people who lodge complains against a facility are provided with protection. The Secretary of Health and Human Services is allowed to impose civil monetary penalties for each violation of the developed staffing plans.
It is also a requirement for all hospitals to submit a public report of all staffing information. The report contains such things as the daily number of licensed and unlicensed staff that provide patient care for each shift. Finally, the bill requires hospitals to collect, maintain and provide data concerning staffing system and patient acuity. The data includes any injuries or illness related to work, nursing vacancy, nurses’ turnover rates, the nursing care hours per day for each patient, and patient outcomes in relation to nursing care.
My Organizations Call to Action Regarding Safe Staffing
My organization does not hold the same position as the Registered Nurses Safe Staffing Act. Some issues are present in the organization that contradicts with the bill. The hospital does not have any committee comprising of registered nurses to provide valuable information regarding the correct staffing plan. The immediate result of this is that there is no proper policy in place regarding nurse staffing. The absence of the policy has led to inappropriate staffing that creates many problems, especially to the nurses. The hospital is understaffed because of the shortage of nurses that is seen all over the country. This has created a situation where the nurse-patient ratio in the hospital is very high. For the nurses to care for all the patients, they have to work for very long hours. Most nurses suffer from fatigue due to the heavy workload assigned to them.
The hospital also uses the nurse to patient ratio model that assigns the number of nurses to a given shift based on the average number of patients in a unit. The problem with this model is that it does not put into consideration the individual needs of a patient. This means that a nurse might take longer than anticipated to cater to a single patient. When this happens, the nurses have to hurry while catering to the other patients to finish their assignments on time. Sometimes nurses work for an extra period after their shift is over to finish their duties. The extra time worked by the nurses is not paid for by the hospital. The staffing approach also creates problems when the hospital admits more patients than usual. To maintain the number of required nurses during such a situation, some nurses have to work mandatory overtime.
The hospital sometimes moves nurses from units with few patients to units with a lot of patients. This to prevent overworking the nurses in crowded units and ensure adequate catering to patient needs. Most nurses do not appreciate the practice and consider the assignment unsafe to both themselves and the patients. This is because some nurses have found themselves working on they are completely new to them. Not only do the nurses lack proper training to perform these duties effectively, they do so without any supervision or help from a more qualified nurse.
Finally, the hospital does not have most modern equipment that can be used to assist nurses while dispensing their care and most work is done manually. As a result, most nurses in the hospital suffer from exhaustion after completing their duties with a small number of them having chronic back pains.
The above-mentioned scenarios have led to high nurses turnover in the organization. This is not advisable because as the hospital will be even more understaffed as they are looking for replacements of nurses who have left. The new nurses will also not start working immediately because they need to be oriented in the organization’s system.
My Perspective on the Organization’s Take
As a nurse manager, I am highly against the organization’s take on safe staffing. This is because the approach has many negative implications that have the potential to harm either the patient or nurse or both.
The nurses in the hospital are overworked due to the high nurse to patient ration and mandatory overtime that lead to the nurses getting fatigued. Fatigue significantly decreases nurses abilities to dispense quality care to patients and may result in various medical errors American Association of Critical Care Nurses, 2016). The errors may be harmful to patients and in some cases may lead to death. In the event of such cases, the nurses license may be in jeopardy (Mensik, 2016)
. The movement of nurses from one unit to another is known as floating and causes unsafe working conditions for nurses (Wooldridge, 2009). For floating to happen effectively, various factors have to be considered. These factors include; the nurses’ expertise level, the patient care requirements, and the patient care delivery system. The problem with my organizations is that it does not consider these factors while floating. If the nurses accept the assignments, they are liable for any issue that may arise. This is because nurses are considered to be accountable for the safety of the patients under care.
The high turnover rate of the nurses in the hospital also has various disadvantages. Finding of qualified nurses to fit the organizations needs may prove to be a challenge because of the shortage of nurses. This may lead to the hospital settling for nurses who do not have enough experience. The orientation of the nurses might also be hurried to get the new nurses working as fast as possible. This situation may also lead to errors because the new nurse will not have understood the working of the organization.
Conclusion
The American Nursing Association promotes the bill that holds hospital responsible for creation and implementation of staffing strategies. This is aimed at solving the staffing crisis of nurses that is affecting the medical industry. My organization has not yet adopted the bill and is still struggling with staffing issues. This has led to overworking of nurses, floating and high turnover rates within the organization. I do not support their take on the Act because the staffing issues have created potentially dangerous scenarios that puts both nurses and patients a risk. I suggest that the organization implement the bill because it will offer solutions to all of their staffing problems.
References
American Association of Critical Care Nurses. (2016). Mandatory overtime. Retrieved April 4, 2016, from American Association of Critical Care Nurses, http://www.aacn.org/wd/practice/content/publicpolicy/mandatoryovertime.pcms?menu=practice
American Nursing Association. (2013). American nurses association empowers nurses to create solutions to staffing challenges. Retrieved from http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/News-Releases-by-Topic/Safe-Staffing-News-Releases/StaffingChallenge-pr.pdf
American Nursing Association. (2016). Adequate nurse education funding, safe staffing and patient safety are among focuses of national nurses week 2006 (3/31). Retrieved April 4, 2016, from American Nursing Association, http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2006/PR033106b8555.html
Mensik, J. (2016). What every nurse should know about staffing. American Nurse Today, 9(2), . Retrieved from http://americannursetoday.com/what-every-nurse-should-know-about-staffing/
Wooldridge, E. (2009). Patient Safety: Rights of registered nurses when considering a patient assignment. Retrieved from http://nursingworld.org/rnrightsps
