Three Important Issues in Nursing
Jufen Long
New York City College of Technology
NUR 4130-84523
Professor: Dr. McGibbon
December 4, 2013
Nursing was once a valued and highly respected occupation, where nurses were content with their jobs. Today, nurses are still respected and valued, but there are so many issues with nursing that nurses who were once dedicated to their job have chosen to pursue a different profession. Three of the most important issues in nursing are the “BSN in ten” idea, the ratio of patients to nurses, and the idea from the IOM- nurses should be full partners with other healthcare providers to improve the healthcare system of the United States.
Recently, there has been more pressure on nurses who have received their diplomas or associate degree to obtain their baccalaureate in nursing degree (BSN). This issue has been a topic of controversy since 1965, when the first position statement of the American Nurses Association (ANA) was released. This statement promoted the idea of having BSN as an entry level requirement. Healthcare reformers want nurses that integrate clinical knowledge and research with effective skills in communication and leadership. Higher education is required to meet these demands. Without a highly educated workforce, the health of the nation will be greatly at risk. Associate degree and diploma nursing programs emphasize clinical experiences and nursing skills needed to provide care for patients. Nurses learn how to treat patients and work in a clinic to understand a hospital environment. A BSN nursing education focuses on liberal studies and holistic nursing that incorporate clinical knowledge, research, philosophical and theoretical methods, and leadership and communication skills. Thus, a BSN education prepares nurses to manage a variety of patient care situations in different healthcare environments with other nurses and healthcare providers (Starr & Edwards, 2010).
The “BSN in Ten” is a bill that would require nurses to obtain the BSN within 10 years of receiving their license. If a BS is not obtained with 10 years, the license will go “on hold”. This bill was made based on evidence that obtaining a BS is helpful to both the nurse and patient. The Institute of Medicine (IOM) is recommending increasing the proportion of nurses with a BSN to 80% by 2020. A large study of surgical patients showed that for every 10% increase in proportion of BSN nurses, there was a 5% decrease in patient mortality rate. Critical skills that are needed in complex hospital environments are taught in BSN programs, which prepare the nurses to work in different types of environments. Nurses are also benefited by obtaining a BSN- several studies have shown that nurses who received a BSN or Masters were more satisfied and stayed in employment longer that nurses who only received and associates degree.
Hospitals do not have enough nurses for all the patients that are receiving treatments. Because of this, more patient deaths have occurred. According to one study, it is estimated that more than 6,700 patient deaths in hospitals can be avoided by staffing more nurses and that around 5,000 of these deaths could be prevented by increasing the number of RNs. Not only does safe staffing prevent deaths, but also reduces hospital and liability costs. A 2009 study showed that by adding 133,000 RNs to the hospitals in the US, patient care costs would be reduced by $6.1 billion. The responsibilities of a nurse have increased greatly because more people are relying on nurses. Nursing is no longer an occupation where nurses just carry out orders, but it is a profession where one has to diagnose a patient, make decisions based on that diagnosis, and act accordingly. With this new role shift, hospital employers are now responsible for the actions of nurses. Hospitals are accountable for any wrongdoings committed by their employees during their employment. By increasing the number of nurses in a hospital, more life will be saved, which allows the hospital to save time and money. A 2004-2005 business case found that by reducing patient to nurse ratio, there was a lower patient death-rate, fewer complications (e.g. hospital-acquired infection), and fewer medical errors (Needleman, Buerhaus, Stewart, Zelevinsky & Mattke, 2006).
In addition, higher nurse staffing levels are linked to better patient outcomes in both general care settings and intensive care units. Studies have shown that higher staffing levels have reduced patient mortality rates and hospital costs. A 2006 comparison of outcomes in California, Pennsylvania, and New Jersey hospitals showed that 30-day mortality rates were 10 to 13 percent lower in California than in the other 2 states. According to Tevington (2011), California is the only state that stipulates in law and regulations a required minimum nurse to patient ratios to be maintained at all times by unit (e.g. Telemetry 4:1 Intensive Care Unit 2:1 patients nursing shift compare to both New Jersey and Pennsylvania 5:1 patients per nursing shift which do not have mandatory patient ratios).
The Institute of Medicine (IOM) wants to empower nurses. The IOM views empowering nurses as a key step toward meeting the requirements that were recently put forth by healthcare reform legislators. In its report, “The Future of Nursing: Leading Change, Advancing Health”, one of the IOM’s key messages was, “Nurses should be full partners with physicians and other health professionals, in redesigning health care in the United States.”
Until recently, policymakers, administrators, and the public viewed nurses as workers who merely carried out tasks for physicians. No one really thought of them as thinkers who make evidence-based decisions and act based on their own judgment. Nurses now need a new set of skills to meet the new standards of being effective leaders and partners. They must see themselves as partners, and have to be taught to be partners. According to the IMO (2010) report, “strong leadership is critical if the vision of a transformed health care system is to be realized. To play and active role in achieving this vision, the nursing profession must produce leaders throughout the system, from bedside to boardroom.”
There are good reasons why doctors and nurses are both reluctant to change to this new policy. Doctors were used to being independent thinkers who were responsible and knowledgeable. Traditionally, the profession of medicine was a job that focused very little on communication and dependence on one another. Nurses were used to be hierarchy in their workplaces- where they carry out tasks that were given to them. Even if these traditions are not as common, nurses are used to working for others. Although nurses and doctors might overcome some of these differences, the tradition still lingers on top of them. In order to collaborate together, both nurses and physicians must change their way of working to accommodate each other (Davies, 2000).
In order to solve some issues in nursing, nurses and hospitals must change the way of working. Nurses should pursue a higher education to enable them to collaborate with physicians and other healthcare providers. Hospitals should increase nursing staff to improve patient outcome. There is still a long way to go, but minor changes can make a big difference in the nursing profession.
Reference
Barter, M., & McFarland, P. (2001). BSN by 2010: A California Initiative. The Journal Of Nursing Administation, 31 (3), 141-145.
Dall, T., Chen, Y., Seifert, Rita F., Maddox, P., Hogan, P. (2009). The Economic Value of Professional Nursing. Medical Care- Official of Journal of Medical Care Section, 47 (1), 97-104.
Davies, C. (2000). Getting health professional to work together. British Medical Journal Barter
Innovation Profile (2004): State-mandated nurse staffing levels alleviate workloads, leading to lower patient mortality and high nurse satisfaction. Retrieved October 31, 2013 from http://www.nationalnursesunited.org/issues/ratios
Institute of Medicine (2010). The Future of Nursing: Leading Change, Advancing Health. Retrieved November 18, 2013 from www.iom.edu/…Future-of-Nursing/Future
Needleman, J., Buerhaus, P., Stewart, M., Zelevinsky, K., & Mattke, K. (2006). Nurse staffing inhospital: Is The a Business Case for Quarlity. Health Affair, 25 (1), 204-211.
Starr, S., & Edwards, L. (2010). Why should I get a BSN? Tar Heel Nurse, 72 (3).
Tevington, P. (2011), Professional Issues: Mandatory Nurse-Patient Ratios. Medsurg Nursing, 20 (5). Retrieved November 18, 2013 from http://christuslaboractionsantafe.org
The Lewin Group, Falls Church, Virginia (2009). The Economic Value of Professional Nursing. Medical Care- Official of Journal of Medical Care Section, 47 (1), 1-133.
