Review of the Issue

      To lead change, one must cultivate cultural competencies, foster supportive settings, and devote resources to innovation and advancement Marshall & Broome (2021); Laureate Education (2015). Unfortunately, emergency rooms serve as a primary care facility for many veterans. These facilities are unable to serve as a primary care clinic to treat chronic diseases and handle the emergencies that come through the door due to an already overburdened population. A major issue facing the US today is the national healthcare stressor of a lack of providers to offer veterans high-quality healthcare (Duerst, 2020). Longer wait times, higher prices, and ultimately lower quality of treatment come from a lack of providers to match the demand for care. Both veterans and their families experience a great deal of stress as a result of this. The lack of suppliers is caused by a number of factors, including:

1. As the population ages, more veterans require more medical attention.
2. There aren’t enough younger providers to step in when many providers reach retirement age.
3. Attracting healthcare professionals to work in the VA system is difficult due to the complexity of the medical system.

The level of treatment that veterans receive is directly impacted by the provider shortage. Veterans frequently have to wait longer for appointments when there are not enough healthcare providers to satisfy the demand. They can also encounter medical professionals that lack the qualifications or experience they would desire. This may result in less effective treatment and, ultimately, worse health outcomes for veterans.

Implemented Changes

      Veteran Affairs (VA) is undertaking substantial changes to providing healthcare services to veterans, similar to many other healthcare systems (Pittman & Scully-Russ, 2016). Veterans now have access to the VA network, community care providers, and urgent care facilities thanks to the VA Mission Act of 2018, which replaced the VA Choice program. This gives veterans options for high-quality healthcare whenever and wherever they need it. Veterans may use community care providers (accepted non-VA providers) for their medical needs instead of the VA. In order for this to take effect,  the veteran’s primary care provider must agree that seeking treatment outside of the VA is in the patient’s best interests, the veteran’s primary care appointments are longer than 20 days, the drive to the VA medical facility is 30 minutes or longer, only a few services are offered at the VA facility, or a mix of all these (Department of Veterans Affairs, United States, 2019). Veterans can receive non-emergent care and treatment for minor injuries in urgent care centers, much like in the community. Veterans in remote places can access virtual medical treatment through the VA’s telehealth program. My health system has increased the number of healthcare providers in response to this stressor on the nation’s healthcare system. This has decreased appointment wait times and improved the standard of service. By offering additional training to healthcare professionals, my health system has likewise sought to raise the standard of treatment. In order to more readily detect and address any issues with the treatment patients receive, we have implemented a system of quality control called the patient safety net (PSN).

References

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer. 

Duerst, L. (2020). The Veterans Health Administration’s Provider Shortage. Health Affairs, 39(2), 304–310. doi:10.1377/hlthaff.2019.00811 

Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: Author.  

Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health, 14(56), 1–15. doi:10.1186/s12960-016-0154-3. Retrieved from https://human-resources-health.biomedcentral.com/track/pdf/10.1186/s12960-016-0154-3Links to an external site.  

U.S. Department of Veteran Affairs. (2019). VA mission act. Retrieved from: https://missionact.va.gov/

Introduction

Nursing shortages are a national healthcare issue. According to Lisa et al. (2022), lack of educators, burnout, inequitable workforce distribution, and workplace violence are some contributors to nursing shortages. These examples lead to high nurse-patient ratios and ultimately increased nurse turnover rates. In this discussion, I will reflect on the negative impact of nurse shortages in my organization and how it addresses the issue.

Impact on the Work Setting

The COVID-19 pandemic has increased the need for mental health services among all ages, causing a surge of patients in an already unequipped situation. When it comes to staffing, it is a matter of supply and demand. By 2025, nursing shortages are expected to exacerbate due to low rates of new nurses and patient demand, mainly due to COVID-19 (Bailey, 2022). Our organization’s supply of nurses does not meet the demand of our patients. Often, patients are stuck in the emergency department for days to weeks waiting for a bed on our unit, further affecting their mental health.

Once on the unit, care can be compromised due to a lack of staff. Working in a psychiatric unit can be very dangerous in itself. Working on a psychiatric unit without proper staffing can be even more hazardous due to the instability and impulsiveness of our patients, who require strict monitoring. Every 15 minutes, a staff member must visualize every patient and document their status in real-time. Often, this is infeasible when there is not enough staffing for a shift and can lead to us being unaware of certain dangerous behaviors happening at that time, compromising patient safety.

Responding to the Issue

My organization has recently started hiring travel nurses to fill staffing gaps in our psychiatric unit. According to Hansen and Tuttas (2022), travel nurses supplement staff nurse vacancies due to attrition, leave of absences, patient surges, and newly opened units (para. 1). In our case, we hire travel nurses primarily for attrition, leave of absences, and because of unit acuity. Travel nurses are beneficial as they also relieve our staff nurses, allowing them to take more paid time off than they usually could.

Our organization also offers bonuses as an incentive for nurses to pick up extra shifts. Bonuses are great; however, they only entice our nurses so much. Eventually, the nurses feel that the extra pay is not worth the extra work.

Conclusion

In conclusion, nursing shortages are a nationwide issue that does not seem to be 100% curable. Unfortunately, my organization’s strategies for responding to this issue are no more than band-aids. Nurses are not interested in temporary fixes. However, due to the many reasons for short staffing, there does not seem as though any intervention will serve as a permanent solution.

References

Bailey, V. (2022, June 28). 200k to 450k nursing shortage expected by 2025 without action. https://revcycleintelligence.com/news/200k-to-450k-nursing-shortage-expected-by-2025-without-actionLinks to an external site.

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. National Library of Medicine, 18(9), 10–14. https://doi.org/10.1097/00152193-198809000-00006Links to an external site.

Hansen, A., & Tuttas, C. (2022). Professional choice 2020-2021: Travel nursing turns the tide. Nurse Leader, 20(2), 145–151. https://doi.org/10.1016/j.mnl.2021.12.018Links to an external site.

HealthCare Issue 

Create settings that foster change, build cultural capabilities, and allocate resources to innovation and improvement to lead change (Laureate Education, 2015). Currently the healthcare system has struggled in many aspects over the current years. More importantly the major struggle came during COVID-19, particularly when healthcare providers began to experience burnout. Burning out health care providers remains a challenge to all organizations nationwide. 

The heightened burn out rate of healthcare providers stems from thew nursing shortage we are currently having nationwide in healthcare providers, which in turn has more of a negative impact on patients and their hospital experiences. As the nursing shortages continue to rise, patient acuity continues to increase and nurses are forced to assume a much larger patient load with more duties that are needed to meet the high-quality care that is expected (Jiang, Li, Gu, & Lu, 2016). The continued increased patient-to- healthcare provider ratio adversely affects healthcare providers and the patient and their family. Many issues expressed at my job through our patient satisfactory survey, after a patient is discharged, the survey is sent out to see where we can improve in the hospital. The most voiced issues are the lack of time the nurse is in the room or the lack of explanation of how their experience in the hospital will go. Burn out is likely to continue to put a strain on the healthcare system and continue to worsen the already pre-existing issues surrounding nursing shortages nationwide. 

Implemented Changes 

At my current organization there is a significant shortage in the nurse-to-patient ratio. The strain comes from the burnout during COVID-19. The high turnover rate at my organization should distinctively tell the institution about staff satisfaction and the burn out status. Losing more experienced nurses at bedside for ten plus years has reduced quality of care and patient satisfaction. But on the other hand, and way in increasing the reduction in quality of care and patient satisfaction would be to increase staffing levels across the healthcare system (Hill & DeWitt, 2018). Understanding the needs of an organization is crucial in improving and changing the fragmented healthcare delivery system nationwide, by doing so would improve overall service quality received by the patient. My organization has already implemented hiring new healthcare workers and training them to be an asset to our units to aid in alleviating our organization in having our max acuity on the unit every day.  

References 

Hill, M., & DeWitt, J. (2018). Staffing Is more than a number: using workflow to 

determine an appropriate nurse staffing ratio in a tertiary care neurocritical care unit. Journal of Neuroscience Nursing, 50(5), 268-272. doi: 10.1097/JNN.0000000000000387 

Jiang, H., Li, C., Gu, Y., & Lu, H. (2016). Nurse Satisfaction and Burnout in Shanghai Neurology Wards. Rehabilitation Nursing, 41(2), 120-127. doi: 10.1002/rnj.174 

Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91-98. doi: 10.1111/inr.12342 

Rathert, C., Williams, E., & Linhart, H. (2018). Evidence for the quadruple aim: a systematic review of the literature on physician burnout and patient outcomes. Medical Care, 56(12), 976-984. doi: 10.1097/MLR.0000000000000999 

Introduction

The national health care issue I chose was one I have experienced since the pandemic started, which is nursing shortages. To meet the population’s healthcare demands, the area of healthcare is constantly expanding and evolving. A substantial portion of the healthcare system is made up of nurses which makes it the nation’s largest healthcare profession (Flaubert et al., 2021). The lack of nurses is currently a problem for the country’s healthcare system. A sufficient work force is essential for improving patient outcomes.

Description of healthcare issue/stressor and how it impacts work setting

Within the American healthcare system, nurses are widely acknowledged to play a crucial role in the delivery of safe and high-quality treatment (Salmond & Echevarria, 2017). Nurses have been feeling overwhelmed for years, but the pandemic was the breaking point for many nurses. During the COVID-19 pandemic, nurses were working under tremendous pressure which resulted in burnouts. These burnouts led nurses to leave bedside nursing. Nursing shortages created unsafe nurse to patient staff ratios. In addition, lack of nurses resulted in inadequate patient care, low staff retention, and an increase in hospital-acquired illnesses. This healthcare issue impacted my work setting and patient experience. Nurses did not have enough time to spend with patients to provide care and compassion because our task list was long, and we were assigned more patients than were supposed to have. According to studies, patients stay longer when nurse-to-patient ratios are higher because complications arise more frequently such as hospital acquired injuries or infections and readmission’s (McHugh et al., 2022). For example, hospital acquired pressure injuries can result from inadequate staffing because it can lack proper wound care and repositioning bedridden patients every 2 hours to relieve pressure on bony prominence.

Response and changes to the healthcare issue/stressor

My health system work setting understood that they had to find strategies to both recruit and keep nurses. The hospital I work for provided exceptional pay for travel nurses to temporarily cover the shortages. However, that was temporary, and they were still struggling to respond to nursing shortage. When my unit was short staffed, nurses were unable to take their breaks which would cause meal break penalties, and per our union contract we would be paid an extra hour for every missed break. This problem was getting expensive for our hospital, so they started offering bonuses for extra shifts. Eventually, they opened positions for nursing staff. Even though the new staff mostly consisted of new graduates, it was helpful to have extra help and hands on the floor.

Conclusion

Nurses were already showing signs of burnout because of stress and understaffing before the pandemic. Stress and understaffing were only made worse by the extra exacerbating factors brought on by the COVID-19 pandemic. Help must be available to nurses so they may safely do the emotionally and physically demanding work that they are tasked with.

References

Flaubert, J., Le Menestrel, S., & Williams, D. (2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK573922/

McHugh, M., Aiken, L., Sloane, D., Windsor, C., Douglas, C., & Yates, P. (2022). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408834/

Salmond, S. & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266427/

Week 1: Main Discussion Post

National Healthcare Issue

I chose to discuss the impact that the lack of mental health providers and resources has had on, not only my facility, but facilities nationwide as well. There has been a shift in how care is being given to patients experiencing mental health needs based on the attention that mental health is currently receiving. The needs are still there, but a lot more is currently being done to combat this issue.

Impact to Current Place of Employment

In my current role within the Department of Veterans Affairs, a large push to address mental health needs has been enacted by bills set forth by President’s in the last few elections. However, even with the growing number of interventions, lack of mental health resources is still a top priority to address. According to Weiner (2022) “Already, more than 150 million peopleLinks to an external site. live in federally designated mental health professional shortage areas. Within a few years, the country will be short between 14,280 and 31,109 psychiatristsLinks to an external site., and psychologists, social workers, and others will be overextended as well, experts say” (para. 3). The greatest impacts that this shortage has made to my current place of employment is large wait times for Veterans to see a provider. Oftentimes, the wait times are so large that the providers must send them to a provider in the community to be evaluated. This causes community providers to become overwhelmed, a risk for completion of suicide due to a wait without intervention, and staff burnout due to an overwhelming amount of Veteran’s on their waitlists.

Response by VHA on this Healthcare Issue

The VHA has made leaps and bounds in regard to addressing the mental health needs of Veterans. Some of the interventions the VHA have implemented are: student loan repayment for those studying Psychiatry, scholarship opportunities for those in social work, psychology, and counseling, improvements to crisis number and crisis response teams, and onboarding significantly many more mental health workers (Hester, 2017). It is also important to note the greater integration of mid-level providers, implementation of virtual or telehealth technologies, and support to primary care physicians  to address mental health needs of Veterans. Doyle & Streeter (2017) explain that broadening the scope of practice for NP’s to address certain mental health needs within the VA has been implemented as well to tackle this issue.

Conclusion

Although mental health services/providers are still in need, the VHA has been making adjustments to their approach on this issue. The onboarding of new mental health workers, support in student loan repayment for mental health workers, and broadening scopes of practice for mid-levels has been instrumental in providing care the Veterans who were having issues obtaining care in the past. The VHA continues to budget more for mental health needs with each passing year and continuously improves Veteran access to mental health needs. The initiative to tackle the specialized mental health needs for Veterans appears to be on the uphill trend.

References:

Weiner, S. (2022, August 9). A growing psychiatrist shortage and an enormous demand for mental health services. AAMC. Retrieved November 28, 2022, from https://www.aamc.org/news-insights/growing-psychiatrist-shortage-enormous-demand-mental-health-services

Hester, R. D. (2017, August 18). Lack of access to mental health services contributing to the high suicide rates among veterans. International journal of mental health systems. Retrieved November 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563010/

Doyle, J. M., & Streeter, R. A. (2017, February). Veterans’ location in health professional shortage areas: Implications for access to care and workforce supply. Health services research. Retrieved November 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269541/

MAIN POST

In today’s economy one major stressors nurses have, is the income compared to the cost of living and unsafe nurse/patient ratios due to nurses leaving which results in a statewide nursing shortage. I live in southeastern Idaho where the cost of living has dramatically increased but nurses pay has stayed the same. This difference has caused many nurses to leave hospitals in search of higher paying jobs. This leaves the nurses that stayed with their current employment with a nurse/patient ratio that is unsafe and can overwhelm the nurse “thus making it difficult for a single primary care professional to manage all patient care needs effectively and efficiently” (Norful et al, 2018). Nurses understand that “continual change in our work environments is a reality of life” (Broome & Marshall, 2021) and we must adapt for this change. Due to the increase of nurse/patient ratio because of low staffing from nurses leaving for better pay the burnout rate among nurses increased which then caused major stress and anxiety among all staff. It is found that “employees with poor well-being were less engaged and more negative about the workplace.” (Jacobs et al, 2018).

The hospital I work for were slow to compensate nurses for the rising cost of living which led my hospital unable to recruit new nurses because the wages were too low. Eventually the hospital was forced to give a cost-of-living raise, this raise has kept many nurses at their current job and has also made the hospital very competitive compared to other hospital wages. As far as the nurse/patient ratio the hospital administration temporally approved unlimited overtime for a period of time for nurses from all departments to help fill in wanted needs until more nurses were hired to help decrease the nurse/patient ratio.

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being: Moving from the Triple Aim to the Quadruple Aim Links to an external site. Nursing Administration Quarterly, 42(3), 231–245.

Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain Links to an external site. Annals of Family Medicine, 16(3), 250–256.

Main Post Week One: Nursing Shortages and Nursing Retention

      In healthcare today, it is no secret that there are significant nursing shortages and a lack of appropriate staffing. This discussion examines the link between nursing shortages and nursing retention within the workforce. According to Foster (2022), scarcity in nursing has been attributed to a decrease in nurses entering nursing and failure to retain nurses already in the field. To summarize, in the nursing field, we have fewer individuals entering the field, and more nurses are leaving the field. These two attributions led to an inevitable decrease in the nursing workforce.

Unfortunately, this nursing shortage is something that many of my colleagues and I have faced firsthand. I work in a small rural Emergency Department that is the closest access to emergency care for many small towns. The unit consists of 13 beds; eight are for higher acuity patients (e.g., MI, trauma, complicated sepsis), and five are for lower acuity patients (e.g., sore throat, minor ankle injuries, skin rash). Staffing consists typically of four RNs, one ED tech, and one ED unit secretary. However, staffing has become increasingly shorter. For example, recently, the unit had only two RNs and one unit secretary. The shift was hectic, and several emergencies presented to the ED. This staffing shortage created many issues, such as increased wait times, decreased patient-nurse interaction, dissatisfied patients and family members, dissatisfied staff, and tension amongst staff. Most healthcare professionals would classify these working conditions as poor or unsafe. The poor working conditions created by short staffing have contributed to the decreasing number of nurses willing to work at the bedside in acute or critical care areas (American Journal of Nursing, 2022).

Addressing staffing issues to increase nurse retention can take time to be fixed. There are, however, measures that can be taken to work towards a better work environment. As mentioned previously, fewer nurses are coming into the profession. New nurses are entering a career plagued with short staffing, making it challenging to cope with stress and develop professionally, which results in new nurses leaving the profession early on (Devi, 2022). To help retain new nurses, there needs to be a focus placed on proper mentorship. According to Davi (2022), adequate mentorship matches a more seasoned nurse, and a new nurse meant to foster growth and development, which will aid in retention. A key aspect of mentorship is ensuring that the mentor and the mentee have a good relationship where the expectations amongst each are clear.

Recently, at my organization, new graduate orientation has changed tremendously. The recent graduate orientation timeframe has been extended, and meetings with the mentor and mentee have been implemented. There are weekly check-ins conducted by the nurse educators where the mentor and mentee can individually express needs or concerns. Because the nurse educators are not within the same department, this has helped create an unbiased environment where both individuals can reach out for help during the mentorship. This new system has helped the mentor and mentee have more self-accountability. Providing recent graduates with supportive and proper mentorship is vital to the future of nursing.

References

American Journal of Nursing. (2022). Nursing Shortage or Exodus? AJN, American Journal of Nursing, 122(3), 12–13.        https://doi.org/10.1097/01.naj.0000822928.16774.9a

Devi, M. K. (2022). Editorial: Mentoring New Nurses. Singapore Nursing Journal, 49(1), 1.

Foster, S. (2022). Reflecting on retention: reasons why nurses choose to stay. British Journal of Nursing, 31(7), 405–405. https://doi.org/10.12968/bjon.2022.31.7.405

The healthcare issue affecting the medical community is a shortage of nursing staff. The increased number of patients over the years continues to grow, significantly impacting adequate staffing levels. Why would individuals want to spend all this time and money on school when they can get a job with better benefits and pay without having someone’s life in their hands?

           Initially, we saw many nurses hitting the road to work these travel assignments for a pay increase. According to Bourgault (2022), healthcare costs are expected to increase tremendously by 2026. One way healthcare is looking to decrease costs is to hire nurses through internal contracts, which would cut out the middleman. The facility I work in has offered full-time staff the opportunity to make extra money when shifts need covering with bonus pay. Christ (2022) stated that nurses do not want to take a decrease in revenue because they have become accustomed to a way of life. By cutting out the middleman with these nurse travel companies, the nurse’s pay can be met in the middle, and the hospital can afford to hire two nurses for the average cost of one travel assignment nurse.      

           Another way to do this is to investigate hiring nurse externs to assist with primary nurses’ job duties. These student nurses are close to the end of their schooling and learn valuable skills while helping with daily tasks. With nursing shortage continually being an issue, patients’ needs might not all be critical, but they continue to be very important. Turale and Meechamnan (2022) stated that the population would be negatively affected if nurses do not start working together and obtaining governmental support. Not enough staff will mean poor outcomes for patients, and with this, more and more nurses will be walking away from the job feeling defeated and exhausted. The nursing community will continue to need support from all medical personnel, and hopefully, one day, the nursing shortage will be a thing of the past. 

References:

Bourgault, A. M. (2022). The Nursing Shortage and Work Expectations Are in Critical Condition: Is Anyone Listening? Critical Care Nurse, 42(2), 8–11. https://doi.org/10.4037/ccn2022909Links to an external site.

Christ, G. (2022). Hospitals eye in-house staffing agencies to combat nursing shortage. Modern Healthcare, 52(9), 14.

Turale, S., & Meechamnan, C. (2022). Investment in Nursing is Critical for the Health of the World: We Need 6 Million Additional Nurses. Pacific Rim International Journal of Nursing Research, 26(3), 371–375.

Week 1 Discussion:

You will select a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

 Healthcare issue

Low patient satisfaction is a severe issue in healthcare that is interlaced with the shortage of workers in the field. Acute healthcare settings deal with patients’ complaints and poor satisfaction surveys during and after hospital stays. Patient satisfaction is the most critical indicator of the quality of care and is considered an outcome of healthcare services (Karaca & Durna, 2019). Healthcare has always struggled with shortages of employees; however, when the pandemic hit in 2020, it worsened the problem and impacted many healthcare settings. Many workers in healthcare initially left the profession due to fear of getting sick with the Covid 19 or worry of bringing the disease home to their loved ones. According to Time magazine, It’s no mystery why about 18 percent of healthcare workers quit their jobs between Feb 2020 and Sept 2021. (Vesoulis & Abrams, 2022). This factor affected hospitals nationwide; as a result, hospitals were willing to pay higher rates to attract nurses and nursing assistants to work for them. According to Time, “Hospital administrators, facing shortages in staff nurses, spend a mint hiring contract nurses, which makes them less able or willing to increase their staff nurses’ pay. So more staff nurses quit to become contract nurses, thus further lowering nurse supply and driving demand for contract nurses. It is a vicious cycle”. (Vesoulis & Abrams, 2022).

  Impact on the work setting

Despite these high-paying contract/travel nursing rates, hospitals are still short-staffed, compromising the quality of care rendered to the patients. There need to be more nurses at the hospital where I’m currently working as a contractor; thus, the nurse-patient ratio changes daily depending on how many nurses show up to work. We do not always have nursing assistants. As a result, there are occurrences of care delays because nurses are often busy completing tasks that techs should do. Many hospitals are dealing with hospital-acquired pressure ulcers because there is not enough staff to reposition patients every two hours, as the literature recommends. In addition, call lights are not answered promptly; thus, there is a higher rate of falls, causing patients to stay longer in hospitals and potentially worsening their condition. According to the Journal of Nursing Management, “Hospital-acquired pressure ulcers not only cause health problems but also pose an economic burden to patients” (Kim & al, 2022). Therefore, patients are not satisfied with the care they receive in acute care settings, and nurses are not happy either because they are burnt out with the assignment given due to unfair ratio, acuity of illnesses of patients, and insufficient support on the units to assist nurses.

Conclusion

Healthcare organizations need help fixing the issues related to short staffing, and they are constantly hiring; however, people resign from these jobs as fast as the hiring process. Thus, hospitals mainly rely on contract/travel nursing. According to Time, It is challenging to fix a problem when you have new people coming in every 12-13 weeks, orienting them to your floor, making sure they know where equipment is, where meds are, and who to call for a problem; it’s constant turnover. (Vesoulis & Abrams, 2022).  Patients are also exposed to continuous change, which affects the quality of care they receive.

 References

Karaca, A., & Durna, Z. (2019). Patient satisfaction with the quality of nursing care. Nursing open, 6(2), 535–545. https://doi.org/10.1002/nop2.237

Vesoulis, A., & Abrams, A. (2022, February 23). Hospitals say nursing agencies are ‘exploiting’ the pandemic. Time. Retrieved November 29, 2022, from https://time.com/6149467/congress-travel-nurse-pay/

Kim, J., Lee, J. Y., & Lee, E. (2022). Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. Journal of nursing management, 30(5), O1–O9. https://doi.org/10.1111/jonm.12928

MAIN DISCUSSION POST

Healthcare is a broad field that is always expanding and changing to address the healthcare demands of the population. The shortage of nurses is one national healthcare issue I have chosen since I have encountered it for the five years I have worked as a nurse. The World Health Organization (WHO) estimates a 7.2 million medical professionals shortage to meet health demands. According to the United States Registered Nurse Workforce Report Card, a shortage of registered nurses is anticipated to worsen nationwide through 2030. Third Global Human Resources Forum for Health’ predicts that by 2035, the shortage of nurses will arrive at 12.9 million (Marć et al., 2019). Nurses play a very important role in healthcare systems. Nursing shortages in surgical units result in dangerous nurse-to-patient staffing ratios. In my opinion, more than merely educating and licensing is needed to address the shortage of nurses. In one year of employment, a fifth of nurses leaves their nursing jobs (Broome & Marshall, 2021). To prevent them from quitting or nurse going to other professions, serious action must be taken to keep experienced nurses in the nursing field and at the bedside.

The nursing shortage has the following impacts on healthcare: Firstly, it leads to poor patient experiences. Nurses spend a lot of their time with their patients, and patients depend on them to provide the best and safest care possible (Larson et al., 2019). Hence, if a hospital has insufficient nurses, it will be hard for the nurses to give quality care to a patient because a lot of errors will be made as the nurse will be dealing with a lot of patients with few resources. Secondly, the shortage of nurses also leads to burnout due to the daily chronic workplace stress that nurses face while trying to meet the many patients’ demands. Due to the high patient-to-nurse ratio, the nurses are sometimes required to work extra shifts to replace the gap of the unavailability of nurses, and therefore they go home tired and fail to have time to spend with their families (Dall’Ora et al., 2020). Burnout also makes the nurses make many mistakes which can cost a patient’s life. The National Academy of Medicine reports that between 35% and 54% of American nurses and doctors experience a number of burnout-related symptoms. Lastly, a shortage of nurses can lead to an increase in cross-infection caused by the nurse forgetting to change gloves, sanitize their hands, or sterilize their tools before attending to another patient due to dealing with many patients and burnout.

At my hospital, the medical-surgical units have a nurse-to-patient ratio of 1:6. Having six patients and the workload accompanying those patients has made me feel inadequate as a nurse and question if I want to be a nurse anymore on many occasions. Nursing is an emotionally taxing job, and I find that sometimes people forget that nurses are more than nurses; we are people. When the pandemic started, my floor transitioned to a COVID-19 medical-surgical floor. The nurse-to-patient ratio changed to 1:4, which sounds much better than 1:6, but was misleading. The staffing changes came at a cost; we often perform total care, and there is little support from other departments such as housekeeping, maintenance, lab technicians, etc. The hospital partnered with a local mental health facility and provided group and individual counseling sessions for those who wanted to attend; hence, the working environment has resulted in a high nurse turnover.

A nursing shortage has a major adverse effect on health care; it is not only an organizational difficulty or a subject for economic analysis. Any nursing shortage, whether local, regional, national, or global, must be addressed to maintain or improve health. The followings are ways my health system work setting has responded to the shortage of nurses: Promoting career development and helping all nurses obtain the highest education is one way the hospital has helped respond to the nursing shortage. The hospital has retained more nurses because nurses will feel more satisfied and appreciated. Another way our hospital has dealt with the nursing shortage is by prioritizing nurse retention levels. Our chief nursing officer has done that by decreasing shift length and overtime, making nurses not quit working. Our chief nursing officer also offered us bonus rewards during the pandemic, which motivated our workforce because we felt our work was appreciated and noticed. Many changes were made in our healthcare system, and expanding referral bonuses was one of them.

Using innovation to address the shortage of nurses is another healthcare method because technology is the solution to almost everything in this century. With technology, nurses can place their patients’ records on a computer. Electronic health records are very useful to nurses because they will reduce their workload as they have no paperwork to deal with. The time they could be used to arrange the papers or look for a lost file can be used to deal with patients, and time wasted can be recovered (Downing et al., 2019). Electronic health record has played an essential role in reducing the shortage of nurses because by reducing workload, many nurses do not get too tired, and the thought of quitting because of too much work disappears. It has also made communication easier and saves a lot of time, giving nurses enough time to rest.

References

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human resources for health, 18(1), 1-17. https://link.springer.com/article/10.1186/s12960-020-00469-9

Downing, N. L., Rolnick, J., Poole, S. F., Hall, E., Wessels, A. J., Heidenreich, P., & Shieh, L. (2019). Electronic health record-based clinical decision support alert for severe sepsis: a randomized evaluation. BMJ quality & safety, 28(9), 762-768. https://qualitysafety.bmj.com/content/28/9/762.abstract

Larson, E., Sharma, J., Bohren, M. A., & Tunçalp, Ö. (2019). When the patient is the expert: measuring patient experience and satisfaction with care. Bulletin of the World Health Organization, 97(8), 563. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6653815/

Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage–a prospect of global and local policies. International nursing review, 66(1), 9-16. https://www.researchgate.net/profile/Joanna-Burzynska-2/publication/326584152