Abstract
The topic of this paper is regarding the effects of the nursing shortage on patient safety and adverse events. Due to the nursing shortage, there is an increase inare registered more patient adverse events and there is increasedthe risk to the patient’s safety increased. If the nursing shortage problem is not correctedsolved, then there will be a continuance ofcontinue increase in the risk to patient safety risk , andas well as harm to the patient. In the paper there is provided Aan explanation of the nursing shortage, the its cause of the shortage, how the shortageit affects patient safety, and the different types of adverse events patients can undergo during their stay in a hospital that has a low nursing proportion to patients. The approached used was that of a review of literature to find supporting evidence of the thesis. According to different studies, the nursing shortage does lead to patient harm, including longer stays in the hospital, urinary tract infections, increased patient falls, pneumonia, patient dissatisfaction, hospital acquired illnesses, and death.
Key words: Nursing shortage, patient safety, urinary tract infections, pneumonia, nosocomial infections, hospital acquired infections, mortality.
Introduction
It has beenwas found that there are nursing shortages that are affecting the many different patients around the world. The nursing shortageIt is becoming a big issue since there are is an increasing number of individuals in need of quality care for their challenging health needs. There are not enough nurses to support these needs . The reasons for this nursing shortage are: A a decrease in the amount number of people entering nursing school, the decrease in the amount ofas well as nurse educators, the an increase in the population, which results in an increase in thegreater number of people in need of health care services, and the increase in the amount number of nurses who are eligible for retirement . Other reasons for the nursing shortage are the evolving roles of nurses, the evolution of technology and the increased education opportunities that comes with this technology, the expanding patient acuity, the deficiency in training, as well as the shortcomings in resources, facilities, and staff .
The nursing shortage is a major cause of adverse events in patients during their stay in a facility. Whether the facilityit is a nursing home or a hospital, if there is a deficit in the nursing staff, there will be an increase in the adverse events of patients. It can therefore be said that the nursing shortage has causedcauses an insufficiency in patient safety. The purpose of this paper is to discuss the nursing shortagethis problem and how it affects patient safety. In this paperaddition, the solutions to the nursing shortage will also be discussed. If hospitals increase the hiring of experienced nurses, these nursesit would will have a positive impact on the safety of the patients and they will be able to mentor newly graduated and inexperienced nurses.
Methods
In this patient paper key words were searched using the Grand Canyon University journal database and the Google Chrome search engine on the World Wide Web. The databases included in the Grand Canyon University journal database include: CINAHL, Social Sciences Citation Index, PsycINFO, and Science Direct. The keywords used during the search were: nursing shortage, urinary tract infection, pneumonia, patient safety, nurse neglect, and medication errors. After analyzing data from the databases and the web, articles were selected for literature review.
Factors Indicated in the Nursing Shortage
One of the factors in the nursing shortage is that there are is decreased length of stays in hospitals and increased raised number of incidences of critical care in ambulatory and home health sites. The increased need of for highly experienced nurses in these types of settings is a challenge that is difficult to meet . It is important to take in consideration the level of experience and training a nurse has when discussing the nursing shortage. Numerically, there may be enough nurses on any given unit to take care of the patients, ; however, if these nurses are not equipped with sufficient knowledge and experience, they will not be able to appropriately care appropriately for the patients.
When nurses have what is perceived to be a heavy amount number of patients, these patientsthey are often subjected to inferior care. This inferior careIt can lead to higher incidences of patients getting pneumonia, urinary tract infections, pressure ulcers, falls, exacerbations of their illnesses, medication errors, pain, and death, amongst other complications of care . When a patient is forced to stay in an unchanged brief or does not have help in getting to the bathroom, this personhe/she becomes susceptible to getting a urinary tract infection. When the patient needs to go to the bathroom and doesn’t have anyone to help him or her get to the bathroom they mayIn addition, in this case, when trying try to get out of bed without assistance, they and put themselves at risk forof falling.
Nurse Working Conditions
Nurses are expected to do more than the work, for which they were trained. With some of the duties performed by nursesthem, a license or skilled training is not needed. For instance, nurses are expected to perform such tasks as passing trays, feeding patients, light cleaning, and directing other subordinate tasks. No matter how many hours in the shift, time is stretched between actual patient care, the multitude of charting, and the other tasks that are neededhave to be performed.
According to Assessing the relationships between nurse working conditions and patient outcomes: systematic literature review a Bae (2011), study showed that nurses who worked in hospitals with perceived improved working conditions had patients who received enhanced patient care . This study helps to present see the relationship between a nurse’s workplace environment and patient care. When there is a better workplace environment for nurses, they will be able to provide enhanced patient care. This leads to a decrease in the adverse patient outcomes patients that can be experienced while in the hospital. The adverse patient outcomes They include such health disadvantages such as: urinary tract infections, hospital-acquired pneumonia, falls, and death.
Experienced Nurses on the Floor
Another aspect of the nursing staff relates to hospitals not having enough nurses with adequate experience and nursing skills. Due to the uneven ratio of nurses with experience and nurses without it, there is a decrease in the amount number of nursing mentors in the hospitals. This It means that there are not enough mentors people in the facility to guide the inexperienced nurses staff without experience . New and inexperienced nurses may plan their day around getting their duties done instead of planning their day according to the assessments of the patient. When there is a high amount number of duties to be completed, the nurses may notcan fail to comply with the duty regimen.
Nurse to Patient Ratios
In aAnother study pertaining to nurse staffing ratios and adequate patient safety and care showed that hospitals that have a minimal amount number of registered nurses and a minimal amount of nurse staffing levels on the floor was related to an increased amount number of damaging patient outcomes . The studyIt also showed that the shortage of nurses added to the fact that patients have had a higher acuity and needed an increased amount of care and attention may lead to a “threat to the quality of care”. Yyet, when there is an increase in the nursing staff to patient ration, there is a direct decrease in patient mortality, patient lengths of stay in the hospital, and overall decrease in the effects of adverse patient outcomes .
In an article in the Singapore Nursing Journal, it was discovered that facilities that used a high amount number of nursing hours per patient day had a decrease in “falls, sepsis, [and] gastrointestinal bleeds” . The article also stated that there was a link between a facility having a larger percentage of registered nurses and the larger greater amount of hours of care provided by registered nursesthem and licensed vocational nurses and these nurses providing better care. Better Enhanced patient care leads to a decrease in adverse patient events in safety. In some hospitals that used a high amount of hours of care provided, had there were low fewer instances of “congenital heart failure mortality, failure to rescue, infections and prolonged length of stay” . When there is a higher amount number of registered nurses working amongst other health care professionals, there is a decrease is in infections and decreased failure to recues. Depending on the health care facility, the type of patients, and the type of adverse patient events that are susceptible to that facility, when registered nursing hours are increased so that the patients receive an adequate amount of coverage and care, there is a decreased risk to the patient’s safety, as well as lower and a decrease incidence in patient adverse events, including falls and death.
Another, benefit of having a high registered nurse proportion is that it helps to decrease the patient’s length of stay in the hospital and decreases the incidence of hospital hospital-acquired urinary tract infections . Most insurance companies do not pay for hospital -acquired adverse events. When these types of eventsthey occur, the hospital can actually lose money. When If the hospitalit provides adequate staffing by increasing registered nurse hours per patient day to prevent hospital- acquired adverse incidents, the hospital facility can actually save money. Due to the nursing shortage, nurses may be forced to work short staffed and the hospital may undergo consequences of not having the proper amount number of registered nurses on the staff or having adequate nursing hours per patient day.
Studies reportedArticles presented in the International Journal of Nursing Studies have reported that hospitals with high patient proportions to nursing staff dealt with a high 30-day death rate and failure to rescue rate in surgical patients . If there is one registered nurse to six patients on a surgical unit, one licensed vocational nurse, and one certified nurse assistant, it is possible for adverse reactions to occur, but it is not likely, as this is considered adequate staffing for a surgical unit. However, if the registered nurse does not provide direct patient care, this nurse’shis/her hours are not to be included in the nurse nurse-to to-patient ratio hours . If the surgical unit is short short-staffed and there are eight patients instead of six patients per registered nurse, then the patients are put atfall under an increased risk of having adverse outcomes. When there are too many patients for the nurse to care for, he or she is not able to tend to these patients individually. There is a decreased ability for the nurse to tend to the patient every two hours, change briefs, properly assess each patient, and communicate with other health care personnel regarding the care of the patient. Additional duties for the nurse may make tending to the patient particularly difficult when there is a nursing shortage. Nurses are trained in being able to perform necessary skills to take care of patients, they are taught how to organize care and set priorities in triaging patients them in order to decide which patients ones are in the most need. Although nurses may not be taught time management skills, this is something that can be learned through experience. However, no matter how organized a nurse is or how proficient he or she is with time management, if there is a heavy nurse workload, the patient’s safety is at an increased risk.
Medication Errors
One of the main goals of every professional nurse is to keep their patients safe. When nurses they work in environments that do not have the required staff and support, both the patient and the nurse are at risk. The patient’s life is at risk and the nurse’s license, and therefore profession and lifestyle, are put at risk. In a situation where a nurse is working on in an understaffed unit and has multiple duties outside of nursing, it makes it difficult to correctly tend correctly to the patient. Circumstances such as this one can put the nurse in an increased risk for of medication errors and neglect. In a study in the Journal of Clinical Nursing regarding medication errors, one of the top reasons for medication errorsthem was stated by nurses to be caused by personal neglect. When there are different things the nurse must attend to in the middle of medication administration, it is easy for the nursehim/her to make an error; either accidentally give the a wrong dose of medication, or give the a medication at the wrong time . The correct way, in which nurses were taught to administer medicationsmedicines, is to give the right medication to the right patient, in the right dose, on the right time, and by the right route . When a nurse is required to administer medications to a large amount number of patients in addition to other duties, it may be easy for the nursehim/her to “get behind” on passing medications. This It means this nurse may be late in passing all of her medication, which and this constitutes a medication error. When the nurse needs to attend to other duties, such as phone calls or a family member stopping him or her in the hallway, the nursehe/she may accidentally give the prepared medication to the wrong person, which also constitutes a medication error. In certain nursing facilities, a licensed nurse may have to be in the dining room, while the patients eat. If the dining time is in the middle of the nurse’s medication pass, this it can take between 45 minutes to an hour and a half out of the nurse’s medication time. When there aren’t enough nurses on the floor, it is difficult to find help or delegate these tasks to the right staff.
The Patient’s Perspective
In a national study, the opinions of the consumers or patients was were discussed regarding their thoughts on patient care. According to this studythem, the reasons consumers are were dissatisfied with their care in the hospital is were because of the low amount of nursing staff. The consumers also thought that the main reasons for medication errors were that nurses were over worked, stressed and had fatigue fatigue-related burnout, had intensified workload, spent insufficient time spent with patients, along with the fact that there not havingwere not enough nurses on the floor .
Discussion
This paper concentrated on how the nursing shorted shortage affected patient outcomes. Through various literature sources, it was determined that increasing the number of experienced nurses on the floor helps helped with the patient outcome. It was also determined shown that having a higher amount number of registered nurses on the floor was beneficial to the patients outcome and lead to decreases in adverse patient events, such as falls, urinary tract infections and pneumonia. The recommendation of correcting the nursing shortage, increasing the amount number of registered nurses, and supporting staff on the floor is helpful to the patients, however, it can be very costly to the hospital. To decrease costsexpenses, some hospitals decided to lower the amount number of registered nurses on the floor and replace them with supporting staff with fewer abilities and skills .
Conclusion
It has been concluded that tThe nursing shortage is detrimental to the safety and lives of patient’s. When a hospital has a low amount number of nurses with a high number of patients, these patientsthey are susceptible to an increase in falls, urinary tract infections, pneumonia, failure to rescue, and death. The stress from working short-handed can be a reason for many medical errors, which in turn can lead to adverse patient events. Although patients benefit from staying in hospitals that have adequate nurse nurse-to to-patient ratios, this it can be costly to the hospital. Further research must be performed in order to determine effective and cost cost-efficient ways fix the nursing shortage and increase patient safety.
Proofreader’s Comment on the Paper
The work provides a strong basis to the justification of the nursing shortage problem. However, there are several important aspects, on which the author has to work:
- There is a huge number of repetitions in text, which makes reading and comprehension very difficult. It is always a good idea to choose some synonym, other structure, some pronoun to decrease the number of repetitions.
- There are several typos and mistakes in the word choice, such as “in the patient” instead of “in the paper” that mean that the author should have read the paper at least one more time to spot such mistakes on his/her own.
- There are numerous mistakes in punctuation, the choice of preposition and articles
- There are several mistakes in the in-text referencing. It is always better to mention the work by providing the surname of the author(s) and the year of the study publishing instead of providing the title of the work or journal of publishing.
- The flow of thought requires further work, as now it is not logically organized. Instead, it looks like some ideas and facts gathered together by some logic not properly presented. Structure has to be better organized, more connecting structures should be used, less repetitions.
- There are no opposing or at least contradicting arguments or facts presented.
- Throughout the paper the same idea repeats all the time with sometimes poor justification. There should be either more facts presented in support, or some other sentences and words chosen so as to make the paper more informative and valuable in terms of scientific meaning.
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