Melissa Ip
Issues in the Profession of Nursing
New York City College of Technology
NUR 4130 – Section 2744
Prof. I. Pearlman
Historically, nursing was a field of work that had originated from religious orders. The responsibilities were mainly task-oriented, such as providing assistance with hygiene, cooking and feeding, housekeeping, and dressing wounds. In more contemporary times, nursing has evolved to become a profession that encompasses not only the previously mentioned tasks, but also includes research, ethics, psychology, areas of specialties, and licensures that dictates one’s scope of practice. Of the many current issues that are important in today’s profession of nursing, I will include discuss why and how nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression, why legislation should mandate a nurse-to-patient minimum, and what measures can be taken to prevent nurse burnout and turnover.
According to the IOM (2011), today’s nursing curriculum is outdated, requiring a new education system in order to ensure safe and patient-centered care. As the general population is living with more comorbidities nowadays, nurses must keep up with the use of new technological tools, as well as managing and collaborating with other health professionals, such as physicians, pharmacists, social workers, and occupational and physical therapists. Nurses should be able to easily transition to higher levels of education to become better able to work in the more modern and complex health care system.
As a new graduate nurse, one is prepared with the minimum entry-level skills and knowledge to begin this profession. However, nurses must engage in continuing education in order to further progress in this profession. As the first step to be able to competently provide care to patients, nurses must be able to progress seamlessly through an improved education system (IOM, 2011). It can be discouraging to continue on in one’s nursing profession when the education system makes it difficult. For example, as a licensed practical nurse (LPN) who was striving to become a registered nurse (RN), I did not have the option to enter into a transitional program within the CUNY school system. The only choice I had was to start over again, beginning with the prerequisites. Although it did little to dampen my desire to advance my nursing profession, I feel that this did indeed hinder the start of my profession. From my standpoint, I could have used this time to begin my goal by learning to collaborate with other professionals and expanding my interpersonal and professional skills in the field. I am positive that I am not the only person who was in this predicament. In the long run, it wastes time to start the degree from scratch, while costing the nursing industry to lose valuable people who cannot afford to invest all that time to begin fresh.
In a 2002 publication of the Journal of American Medical Association, a study linked higher patient-to-nurse ratios in hospitals with higher patient mortality and higher nurse dissatisfaction with their jobs. Each additional patient per nurse was associated with a 7% increase in the likelihood of patient mortality and a 15% increase in job dissatisfaction for nurses (Rajecki, 2009). In January 2004, California became the first state to mandate the legal patient-to-nurse ratio of 5:1 in medical-surgical units. In 2006, more than 22,000 RNs from 604 hospitals were surveyed. These hospitals were in California, which was the only state with mandatory nursing staff ratios in hospitals, and in New Jersey and Pennsylvania, which were the comparison states. The outcomes of more than one million patients who had common surgical procedures were studied. On average, the nurses in California cared for one patient less than the nurses in the comparison states (Aiken, 2010).
In New Jersey, only 19% of medical-surgical nurses reported workloads that were as good as the California mandated levels. In Pennsylvania, the percentage was higher at 33%. Studying the outcomes have shown that an increase in the number of nurses is associated with fewer deaths, shorter hospital stays, and lower rates of complications such as pneumonia, shock, and cardiac arrest (White, 2006). As a result of California’s mandatory ratio, hundreds of fewer patients die each year per 1,000 general surgical discharges when compared to the comparison states (Aiken, 2010). In the long run, it would be safe to presume that patients would benefit from better nurse staffing.
However, the American Nurses Association (ANA) opposes mandating staff ratios because it can lead to an inflexibility in adjusting ratios and the possibility of reducing ancillary staff in order to finance the increased amount of RN staff (Rajecki, 2009). It occurred to me that hospitals could potentially reduce the amount of admissions just to meet the staffing ratio mandate. This could lead to dire consequences, affecting the quality in delivery of care and reducing the amount of access that patients would have to proper care.
In a 2007 RN National Database of Nursing Quality Indicators Survey Report, over 50% of the nurses reported that they did not have sufficient time with patients (Rajecki, 2009). Having to bear the burden of working extra hours as a result of the inadequate staffing can greatly affect the quality of a patient’s care, as well as the nurse’s satisfaction with the job.
Job satisfaction can be directly affected by staffing levels. Consistent job dissatisfaction can lead to a higher incidence of turnover intention and actual turnover. One of the reasons that can lead to this outcome would be a concept known as burnout. First reported by Freudenberger in 1974, it can be described as a state of chronic stress while in the work setting (Sasaki et al., 2009). After more than 25 years of research, it has been studied throughout many professions and is now measured with a grading scale known as the Maslach Burnout Inventory (MBI). While there are three versions of this tool, the version that is used to assess for burnout in general professions is the MBI-General Survey (MBI-GS).
Burnout can be described as the feelings of overwhelming stress that healthcare workers feel on the job. This psychological syndrome is based on three aspects: lack of accomplishment and a sense of ineffectiveness, emotional exhaustion, and depersonalization and feelings of cynicism (Leiter&Maslach. 2009; Quattrin et al., 2006).
There are numerous possible causes that can lead to this state, such as insufficient training, heavy workloads, lack of nurse autonomy, poor relationships with the medical staff, and lack of access to resources (Happell, 2008). The burnout syndrome can lead to a decline in the quality of care delivery and other psychological issues, such as depression and anxiety (Quattrin, 2006). In order to promote a positive professional environment and prevent the occurrence of burnout, there has to be adequate staffing, good relationships between the multidisciplinary teams, and positive hospital management and organizational support. Preventing stressing from becoming chronic can guarantee continuity in the delivery of high-quality care in the work environment.
In a study that was performed in Japanese hospitals, differences in coping mechanisms for stress were found among men and women (Sasaki et al., 2009). As the gender that has been conditioned by society to be more emotional, women were more likely to seek emotional support than men. The way that men learned to cope with stress was to engage in the use of problem solving. Overall, certain coping mechanisms and strategies that were identified were physical exercise, rest, and hobbies.
In conclusion, the three issues that were discussed in this paper can all be linked together and cause a rippling event. If student nurses are not better prepared to work in a healthcare system that is becoming more and more difficult to navigate, they may feel overwhelmed in the work environment and potentially consider leaving the profession. In addition to an exhausting workload without adequate nurse staffing, nurses will be prone to increased errors, decreased productivity and morale. This can lead to less satisfaction with their jobs and a substandard quality in the delivery of care to their patients. It is important to note that nurses who are experiencing burnout are more likely to affect other nurses by projecting aggression onto others (Rowe, 2005). This will lead to more dissatisfaction in the working environment and will eventually lead to more nurses leaving their jobs. In order to prevent further compromise to the quality of care that is being provided to patients, improving nurse staffing and management can ultimately be the answer to improving outcomes for both nurses and patients.
Works Cited
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IOM (Institute of Medicine). (2011). The Future of Nursing: Leading Change,
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Leiter, M.P., &Maslach, C. (2009). Nurse Turnover: the Mediating Role of Burnout.
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Quattrin, R., Zanini, A., Nascig, E., Annunziata, M.A., Calligaris, L., &Brusaferro, S.
(2006). Level of Burnout Among Nurses Working in Oncology in an Italian
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