Term Paper:
Effects of Staffing/Shortages on Nurses
Dierdre Paul
New York City College of Technology
NUR 4130
With the advancement of technology, people are living longer than before. As the life expectancy continues to rise, more people are being diagnosed with chronic diseases such as diabetes and hypertension. At times, these illnesses can lead to failure of organs or other diseases. Nurses play an integral role in helping the patient recover. Nurses are taught how to provide care that is safe, effective and patient-centered. With dangerous nurse staffing and an unsatisfactory work environment, it becomes difficult for nurses to provide safe care. State mandated safe staffing ratios are necessary to ensure the safety of patients and nurses. Having inadequate staffing endangers patients and drives nurses from their profession. The purpose of this paper is to inform the reader about nurse staffing issues. It also informs the reader how staffing ratios along with bad work environments affects the nursing profession.
According to the American Nursing Association (ANA), California became the first state to pass legislation mandating licensed nurse–patient ratios for units in acute-care hospitals. The ratios are the maximum number of patients that may be assigned to a Registered Nurse (RN) during one shift. The law required that additional RNs be assigned based on a documented patient classification system that measured patient needs and nursing care. The document also included the severity of illness of the patient and complexity of their clinical need. The law restricts assignment of unlicensed staff and nursing staff in hospital clinical areas where they do not have demonstrated competency, training, and orientation.
This law enabled nurses to provide patient-centered care to their clients and also allowed them to focus more on the task at hand such as the assessment of the patient. After California passed the law mandating safer nurse patient-ratios, 15 other states passed similar laws in an attempt to correct the staffing issues. California is the only state to have laws and regulations that demands mandatory nurse-patient ratio in all units (ANA, 2015).
Improper nurse-patient ratios has a major affect on the nursing profession. It is one of the factors that contributes to the nursing shortage. Having high patient ratio creates a dangerous and overwhelming environment for the nurse. High patient-to-nurse ratios have been shown to lead to frustration and job burnout, which is linked to higher nurse turnover. Research has shown that hospitals with better nurse staffing experience better nurse outcomes. Nurses with better patient ratios have better job satisfaction and less burnout.
A quantitative study was conducted by Hairr, Salisbury, and Johannson to show the relationship between nurse staffing, job satisfaction, and nurse retention in an acute care hospital environment. In the study, Registered Nurses with at least 6 months experience in acute care were surveyed. The inclusion criteria for the study included; RNs with a minimum of 6 months of direct patient care experience and employed in an acute care hospital. Other inclusion information included age, gender, academic preparation for licensure (ASN or BSN) and nursing specialty if any.
The researchers used the Nursing Work Index (NWI) survey which consisted of 65 items on a 4-point Likert- type scale ranging from 1 (strongly agree) to 4 (strongly disagree). The participants were asked the following questions: How many patients were assigned to you at the beginning of your last shift? Has the number of patients you have been assigned resulted in job dissatisfaction? Have you thought about leaving your current nursing position in the last 6 months due to job dis-satisfaction? The questions helped the researchers understand the type of environment the nurses worked in. The results of the study proved that there is a relationship between job satisfaction and an appropriate patient assignment. Reducing the number of patients a nurse is responsible for during a work shift would improve job satisfaction (Hairr, Salisbury, & Johannson, 2013).
Nurse staffing issues and shortages is not only a problem in the United States. Other countries such as Canada experience staffing issues and shortages as well. “Canadian nurses are challenged by the same workforce dilemmas and report being overworked, stressed, and generally ill” (Cummings, 2013). Disappointment, and disillusionment with the nursing practice are other factors that leads to shortages of nurses. During clinical rotations in nursing school, student nurses are usually paired with a single patient. Upon graduation and passing the NCLEX, nurses are expected to care for multiple patients without having a full grasp of clinical nursing. This leaves many new nurses in shock once faced with the reality of nursing. Many feel unprepared to care for multiple patients in a shift. As a new graduate nurse, I’ve heard of many stories from my fellow graduate nurses that they were simply unaware of what true nursing entailed. Some of them quit nursing after a few months of work because of the amount of paperwork and documentation that they had to complete at the end of their shift. Constantly being called and multitasking different tasks while caring for patients can be extremely frustrating and overwhelming.
Improving work environments has been recommended as an effective strategy of solving the nursing shortage through promoting nurse job satisfaction and reducing burnout and nurses’ intentions to leave their job (Nantsupawat1 & Kunaviktikul, 2016). In order to improve nurses’ job satisfaction and reduce burnout, attention should be paid to improving staffing and resource development. Hospital managers and policymakers should develop strategies that helps improve the work environment. Some strategies
managers can use is to provide adequate staffing and patient ratios. This would allow nurses enough time for each patient and be able to discuss patient care problems.
As researchers examine what motivates nurses to remain in their current work environments, they have determined the following: workload, recognition and scheduling all impact a nurse’s decision to stay. With regard to the nurse shortage, I believe having adequate staff is one of the biggest contributing factors. With adequate staffing, nurses are able to practice within their full scope while providing the patient the care he/she needs. Being content and satisfied with the job is another factor that can help with the shortage of nurses. Nurse should work in positions that allows them to expand his/her career. Working in facilities without career advancement can lead to job dis-satisfaction. They should also work in a specialty that they’re passionate about. For example, nurses that love to work with children should care for pediatric patients and not settle for positions in other specialties. All of the aforementioned factors help nurses achieve job satisfaction and in turn helps with the retention of nurses in the profession.
REFERENCES
– Cummings, G., Olson, K., Hayduk, L., Bakker, D., Fitch, M., Green, E., Butler, L., and Conlon, M. (2013). “The Relationship Between Nursing Leadership and Nurses’ Job Satisfaction in Canadian Oncology Work Environments.” Journal of Nursing Management, 16(5), 508–518.
– Hairr, D. C., Salisbury, H., Johannsson, M., & Redfern-Vance, N. (2014, May 1). Nurse Staffing and the Relationship to Job Satisfaction and Retention. Nursing Economics.
– Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O., Thienthong, H., & Poghosyan, L. (2016). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91-98. doi:10.1111/inr.12342
– Nurse Staffing. (n.d.). Retrieved November 11, 2018, from https://www.nursingworld.org/practice-policy/advocacy/state/nurse-staffing/
Wit Analysis:
Wit Analysis
Dierdre Paul
New York City College of Technology
NUR 4130
10/22/18
The movie Wit examines the internal life of an English professor suffering a terminal illness. As the movie progresses, the interactions between the professor and her healthcare providers are portrayed and shows how the way they provide care to her affects her. The movie follows the professors life from her diagnosis to her final moments in the hospital. It opens with the professor, Dr. Vivian Bearing in a hospital gown being diagnosed with stage 4 metastatic ovarian cancer. She is advised to undergo an 8 month treatment program due to the fact that she had an aggressive cancer.
Throughout the movie, Dr. Bearing’s daily care is overseen by her nurse Susie Monahan and a young medical oncology fellow and former student of Bearing’s, Dr. Jason Posner. While delivering care to Bearing, Dr. Posner lacked compassion and viewed Dr. Bearing as an experiment. He was more interested in learning more about her cancer than treating her as a whole. He offered little to help with comfort and became more concerned with her finishing the 8 rounds of treatment.
Dr. Bearing’s nurse, Ms. Monahan treated Bearing with kindness, respect and compassion. Monahan acted as an advocate for Bearing, as the chemo treatments continued to have negative effects on her. Monahan helped Bearing make important decisions about her end of life care once she realized she was near death. She informed Bearing about advanced directives where Bearing decides to have a Do Not Resuscitate order. As her nurse, Monahan treated Bearing with kindness and compassion and allowed her to continue to have autonomy over her care while Dr. Posner ignored her requests.
At times, doctors become more focused on treating the issue/disease at hand while neglecting how the patient may feel or what they would want. I believe that nurses are in a perfect position to be patient advocates because sometimes doctors may feel the patient doesn’t know what should be done or what’s best. I have witnessed and experienced doctors treating their patients as cases and not as a person. While being induced for labor with my daughter, the attending doctor explained that the cervix was not dilating and I would need a c-section. I knew there were other methods to dilate the cervix and declined the c-section. I spoke with my nurse and explained to her that having a c-section was not what I wanted and would want to try for a vaginal birth. My nurse told me she would see what she can do. Moments later, another doctor walks in with a foley bulb catheter to dilate the cervix. By 4am I was 5cm dilated and almost ready to give birth. If my nurse had ignored my concerns and did not advocate for me, I would’ve delivered my baby via c-section. Physicians and healthcare providers should always put the wants and needs of the patient first. I believe they should try everything possible to make the patient comfortable, allow them autonomy and control of their care. They should remember that they’re treating the patient as a whole and not just the disease/illness.
