Three of the Most Important Issues in the Profession of Nursing Today
Andrea Vera-Zambrano
Professional Nursing Practice
Section 8548
Professors: Tina Heinz & Candy Dato
April 3rd, 2013
               As nurses, we are always trying to make clinical decisions that reflect not only our professionalism and expertise but our ability to provide quality and safe care for our patients. Our main goal is to advocate for our clients and make sure they feel satisfied of the services they are receiving. However, this ideal goal is not always easy to achieve, and the reasons of it have to do with the drastic changes that our health care system is constantly facing (Swiadek, 2009). Many of these changes are related to measures that the government and healthcare organizations are taking to ensure that clinical decisions and interventions are being cost-effective and financially worthwhile for them, and not the patients. Today, these types of thoughts have unfortunately caused the health care system to start falling apart; and with it, many controversial issues have arisen for the nursing profession. From all the nursing issues being currently faced, I have decided to focus my paper on the nursing shortage, the mandatory minimum staffing ratios and the Institute of Medicine’s (IOM) recommendation of increasing the number of nurses with a bachelor’s degree to 80 percent by 2020.
Despite all the efforts made to overcome the challenges that come along with the scarcity of nursing personnel, the shortage of nurses is still prevailing; creating an obstacle for health care providers seeking to offer effective services. According to the American Association of Colleges of Nursing (AACN) (2010), “in the United States, nursing workforce projections indicate the registered nurse (RN) shortage may exceed 500,000 RNs by 2025”. These statistics offer us an idea of how significant the issue is becoming; the shortage seems not to stop any time soon. The main concern of this problematic is the fact that we may end up affecting the care and outcome of our patients by not having enough licensed providers attending their needs (Huston, 2010). However, in order to better understand the profound significance of the shortage, we must first examine the factors that are influencing and pushing it to the point where it currently is. Many believe that the shortage is the result of a population imbalance, where the number of aging people (baby-boomers) exceeds the total number of habitants that belong to the younger generation; which consequently produces an increase in patient census in healthcare facilities (Fox & Abrahamson, 2009). On the other hand, Huston (2010) thinks that the issue of lack of nurses can be related to an aging workforce (retirees not being replaced with an appropriate number of prepared young nurses), an increase in the acuity of admitted patients or to the higher demand for well-educated and specialized nurses that are able to keep up with the advances in technology and medicine. However, this author considers that difficulties with nursing education and work dissatisfaction are bigger determinants of the current staff shortage.
The idea of placing the educational system as a contributor of the nursing shortage exists because of issues such as lack of funds or faculty that cause nursing programs to reduce their size or even close. There is a major complaint that colleges or universities are not being granted with adequate teaching resources and a proper number of educators to teach students who are interested in pursuing a career in nursing (Huston, 2010). Thus, because of this, applications are either put on hold or turned away; excluding qualified students from the profession. Nevertheless, there are arguments that highlight poor work environment as the root of the problem. Buchan & Aiken (2008) express how the shortage of nurses exists not because there is a lack of people with nursing qualifications, but because there are not enough nurses wanting to work under the “present” conditions. There is a higher turnover of nurses who even leave the profession in some cases because they are not satisfied with things such as mandatory overtime, salary, undesirable working hours, limited autonomy, lack of support, etc. Unluckily, work dissatisfaction is the least addressed factor when identifying potential solutions for the shortage (Huston, 2010).
In order to find an answer that helps solve the whole issue, it is imperative that we analyze what has been done so far to solve this nursing issue. It is also important to recognize if those interventions have worked or not or if they are in the process of making any positive change. The major intervention to alleviate the shortage has been the importation of foreign nurses, which seems to be effective as an immediate measure to supply hospitals with an appropriate number of nursing staff, and subsequently improve the safety and the care delivered to the patients. However, this solution has been found to be very debatable for its negative implications such as the burden it produces on the healthcare system of the country where the nurse migrate from and the depression it causes on the wages of the U.S. wages (Fox & Abrahamson, 2009). Another intervention that has had some questionable results is the implementation of the mandated nurse-patient ratios law; an issue that will be further discussed in the following paragraph.
It would be very arbitrary to categorize mandatory minimum staffing ratios as either positive or negative because, as mentioned above, this issue still remains extensively controversial. Yet, what has made this subject become part of the discussion is the idea that a consistent RN staffing can help improve the quality of care and patient outcome, decrease nursing shortage and increase job satisfaction; and these are all things that the profession of nursing is on immediate need of (Unruh, 2008). The main point of mandatory nurse-patient ratios is to have nurses providing care for a fixed number of patients. The number of patients would be established based on the acute care unit; therefore, every department would have a different ratio set up. Evidently, after understanding the potential benefits of imposing such law; legislators, health care institutions and the general population have demonstrated their support for a change that enables this practice (Huston, 2010). But, is it really worth it to be led by such law?
California was the first state to implement the mandatory nurse-patient ratios as a law for organizing the staff. For them, however, it was not that easy to have everything set and running. It took them some time to determine what the ratios were supposed to be and what type of nursing personnel was this legislation applicable to (whether the law was going to apply for RNs only or if it was also going to include licensed practical nurses, etc.) (Huston, 2010). In any case, after this law finally became part of the everyday practice of all hospitals in California, it started to serve as a model for other states to see and identify if adhering to it could really make a difference in terms of patient outcome and nurses’ burnout and turnover. The reactions about the existence and implementation of this legislation became very arguable; while some looked at it an initial step towards improvement in safety of not only the patients but also of the nurses, some others concurred that the potential law would only put more pressure to the already weakened health care system of the United States.
Although every attempt to provide consistency and protection has been made through the planned incorporation or actual materialization of this law, there is still not enough evidence that guarantees the total benefit of all parties involved. Indeed, the argument of whether or not integrating mandatory nurse-patient ratios have arisen implications such as the fact that it does not consider important factors such as patient acuity, individual treatments, length of stay, environmental limitations, etc. (Douglas, 2010). In addition, it is thought that the fixed ratio setting fails to address critical factors such as nurses’ expertise, education and level of knowledge when giving assignments to the staff. Moreover, Buerhaus (2010) considers that the inflexibility of this mandate may be touching the financial aspect of the health care structure and that it may also be affecting patient quality care and nurses’ autonomy if input from the staff, regarding patients’ individual needs is ignored. Finally, the American Nurses Association (ANA) beliefs that instead of focusing on an idea that fails to incorporate budget realities and the present nursing shortage, the attention should be placed on a more realistic solution that takes into account all possible aspects to ensure safe staffing (Trossman, 2008). However, because of the complexity of the issue, it has taken many years for other states to come up with a uniform solution that secures the benefits of both patients and nurses.
On the other hand, a third topic of discussion may arise when looking at approaches that could help ensure the delivery of safety interventions while applying competent and appropriate techniques of care. According to Hendren (2011), it is through education and training that we (health care providers) get the opportunity to learn about medical and scientific technology, evidence-based practice and cost and time-effective interventions. So, because of the complexity of the current health care system and the challenges of the existing methodology of care, it is imperative that we address educational issues in nursing such as the recommendation of the IOM (2010) of “increasing the proportion of nurses with a baccalaureate degree to 80 percent by 2020”, which has become a subject of questioning by many in the profession.
The main idea of this recommendation is to utilize methods that serve as a mean to encourage nurses with a diploma or associate’s degree to enroll in a baccalaureate nursing program, so that the proportion of nurses with a baccalaureate degree can increase from 50 to 80 percent by 2020 (IOM, 2011). The IOM report also mentions how collaboration from private and public funders, health care and community organizations, nursing commissions and nursing schools could help materialize this goal. Their contribution may focus on the provision of funds, loans, promotions, time differential pay, etc., so nurses could feel more motivated to go back to school. However, as with the previously discussed issues, this proposal of the IOM carries out some conflicting responses and opposed opinions not only from nursing staff and leaders but from organizations seeking solutions to solve professional issues so that the whole national health care system can be improved.
As expressed by Hendren (2011), there is a present need for highly educated and better prepared nurses that are able to use critical thinking skills to face the current challenges of the profession. The suggestion of having nurses going back to school to obtain their bachelor’s degree is based on the concept that baccalaureate nursing programs help students to enhance their professional development; prepare them for a broader scope of practice; encourage them to use evidence-based research on their practice and teach them how to have a better understanding of the cultural, social and economic issues that may be affecting their patients (AACN, 2012). With the reinforcement of all of these skills, nurses may be able to incorporate them on their current practice and provide a more effective delivery of care. However, according to Hendren (2011), the IOM proposal may also have a negative counterpart. She argues that increasing the educational requirements to start practicing or pushing nurses to obtain a bachelor’s degree by a certain time will make the nursing shortage problematic even worse. Students pursuing their nursing education would take longer to graduate and to join the working team, and those nurses already in the field would feel rushed and stressed out of having to comply with a “deadline”; so they may feel dissatisfied or unappreciated and may end up leaving the profession.
In conclusion, as reviewed on this paper, there are many the issues being currently faced by the profession of nursing, which are unfortunately affecting not only the way how care is delivered and perceived but also the health outcome of our patients. It is important that, as nurses, we recognize these arguable situations and advocate for a change, especially when the safety of those under our care is in jeopardy. Let’s raise our voice and let mangers, directors and legislators know what our concerns are and what we think is safe for patients and ourselves.
References
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