Analysis of Pertinent Healthcare Issue – Nurse Staffing
Priscilla Asare
Walden University
NURS – 6053
Dr. Elvira Phelps
March 13, 2022
Analysis of Pertinent Healthcare Issue – Nurse Staffing
Nurse staffing is a critical healthcare issue that necessitates strategies with better outcomes for caregivers and patients. Accordingly, research has linked nurse staffing with patient outcomes, including mortality and morbidity rates. For example, according to Twigg et al. (2021), an increase in patient workloads for nurses creates adverse outcomes for patients, such as higher rates of mortality and longer periods of stay. Additionally, staffing concerns in inpatient facilities have resulted in additional hospitalization costs, as well as decreased quality of life for patients (Lasater et al., 2021). With the increase in the rate of adverse patient outcomes attributed to poor mental health, approaches aimed at leveraging the staffing of nurses are critical. In my facility, nurse shortage is a primary concern due to the recent increase in patients with substance use disorders. Despite financing provided by the Biden administration via the Substance Abuse and Mental Health Administration (SAMHSA), the number of patients with substance-related issues, primarily opioid use disorders, has increased significantly, resulting in considerable demand for nurses in the respective facility.
Description of Issue & Quantification of Impact
In my facility, the increasing population of patients with substance use disorders has added a considerable strain for nurses. Prior to the respective issue, the nurse-to-patient ratio was 1:1. This ratio allowed each nurse to focus on a single patient, except in conditions involving patients with serious conditions. While such emergencies allowed the facility to add more workloads, the ease of transition, as well as the availability of local community resources, provided a sufficient means of support for caregivers. As such, nurses in my facility were not subject to issues that normally affect caregivers in intensive settings, such as high intent to leave, dissatisfaction with the workplace, stress, and burnout (Twigg et al., 2021). However, the onset of the pandemic coupled with the increase in opioid prescriptions due to the relocation of patients to domestic environments abruptly amplified the population of persons with opioid use disorders. In addition, the lack of screening programs aimed at the detection of alcohol and drug use among inpatients complicated the respective situation, resulting in higher adverse outcomes for clients, as well as nurses.
Summary of Literature Reviews
Current research has established a link between staffing and patient and nurse outcomes. In a systematic review of studies examining the association between missed care and staffing, Griffiths et al. (2018) found that the respective relations affected the rates of negative patient outcomes such as in-hospital mortality. Despite the lack of causation between the respective elements, the study discovered that low levels of nurse staffing resulted significantly in higher levels of missed care and consequent rates of mortality among hospitalized patients (Griffiths et al., 2018). Another study analyzing the association between registered nurse (RN) staffing, nursing support, and inpatient mortality discovered that low levels of RN conscription and caregiver support increased rates of in-hospital mortality (Needleman et al., 2020). Accordingly, shifts constituting low populations of nursing support and RNs increased mortality outcomes for inpatients despite efforts aimed at the equal distribution of workloads across three facilities with more than 2,000 beds (Needleman et al., 2020). The respective studies affirm current evidence encompassing the correlation between staffing and adverse patient outcomes, particularly in inpatient contexts.
How Other Organizations Have Addressed the Issue
Despite the challenges affecting my facility, organizations involved in the treatment and rehabilitation of substance use disorders have managed to handle staffing concerns and adverse patient outcomes effectively. For example, some of these facilities implemented minimum nurse staffing ratios derived from healthcare regulations implemented in the state of California (Twigg et al., 2021). The application of these standards allowed for the ease of distribution, as far as nurse workloads are concerned. Using an average nurse-to-patient ratio of 1:1, the facilities in question were able to improve patient outcomes, such as reductions in in-hospital mortality. As an added bonus, the application of minimum staffing standards led to an improvement in nurse outcomes. For example, the equal allocation of nurses to patients resulted in low workloads, which in turn prevented illnesses associated with the job, such as stress and burnout, increased job satisfaction, and reduced the caregivers’ intent to leave.
Strategies to Address Organizational Impact
Evidence from the selected studies affirms the identification of missed nursing care as a way of dealing with staffing challenges in inpatient facilities. Accordingly, the association between staffing and patient mortality also derives from the lack of reports regarding nurses who missed their workloads (Griffiths et al., 2018; Needleman et al., 2020). Based on these outcomes, the measurement of missed care as a key performance indicator (KPI) provides adequate opportunities for improving patient outcomes. Measuring missed care allows facilities facing staffing concerns and adverse outcomes to determine the level of deterioration, especially in terms of emergency responses to patients with debilitating conditions (Griffiths et al., 2018; Needleman et al., 2020). Additionally, the use of missed care as a core KPI allows facilities to allocate staffing based on their internal characteristics. As such, it allows facilities to customize staffing standards that correlate with their outcomes. However, the negative aspect associated with missed care as a measurement factor concerns its reactive aspect. The respective approach is not proactive and, therefore, prone to risks of uncertainty.
Developing Organizational Policies and Practices
Healthy work environments seek to maximize the health and wellbeing of nurses for them to achieve the best possible patient outcomes. The shortage of nurses is a factor that has far reaching implications on the work environment. To design effective and productive organizational policies to address the nursing shortage, leaders need to have a comprehensive understanding of nursing and corporate needs. Each organization faces competing needs as employees and employers have different goals. Employers with to meet corporate goals whereas nurses have individual objectives. Borrowing from the results of Module 2, establishing well-designed and thought off organizational policies is the most feasible way to address nurse staffing issues. Strategic nurse staffing is important to both the nursing profession and the entire healthcare system. While nurse shortages continue to impede the operations of hospitals, eliminating poor nurse staffing practices and policies can help existing nurses deliver quality care.
Description of Competing Needs Impacting Nurse Staffing
When it comes to nurse staffing, one key competing need is the healthcare organization’s mandate to provide patients with high quality medical service. Patients pay to receive good nursing services. According to Moloney (2020) the law dictates that each person has the right to access quality healthcare. Therefore, managers and leaders have to ascertain their respective medical institutions have sufficient technical and human resources to deliver quality care. As a result, many healthcare organizations introduced the 12-hour shift for nurses. The strategy has been used to ensure the availability of nurses. However, the 12-hour strategy can have adverse implications on patient safety due to the insufficient time accorded for nurses to rest (Moloney, 2020). Without good rest, nurses might not have a positive psychological state to prevent medical errors or the provision of poor medical care.
Individual goals represent another competing need in nurse staffing. Every nurse working under an employer does so to fulfil individual financial obligations, including taking care of families and meeting household utilities (Gab-Allah et al. 2020). In a capitalistic society, people work to lead a comfortable life. The need results in nurses pushing for higher salaries and wages. The competing need comes at the expense of the employer. Corporate owners and managers strive to acquire a substantial return on investments (ROI). Higher salaries and wages will reduce the profit margin. Nurse salaries contribute to the escalating health costs, representing a healthcare stressor that impacts the operations of many healthcare facilities. Having highly skilled nurses requires a heavy financial investment, including payments for further professional development. Managers have to address this competing need because failing to address nurses’ financial requirements translates into a higher employee turnover rate.
Description of a Relevant Policy or Practice
Policy and practice should support nurses to succeed and grow in their work. Having worked in a detox facility for drug and alcohol users, one of the organizational policies I have seen affecting nurse staffing is the directive to hire short-term contractual nurses. Each entry employee in the facility does not receive a contract agreement that exceeds five years. Nurses who wish to continue working with the organization have to renew their contracts with new terms and conditions every five years. The lack of employment stability significantly impacts employee motivation and performance (Gab-Allah, 2020). The organization set the policy as a strategy to minimize operational costs caused by highly skilled and experienced nurses. Long serving employees have more bargaining power to negotiate higher salaries and wages.
The nurse recruitment policy has a negative effect on healthcare service delivery and overall quality. The aforementioned policy makes the more experienced nurses feel less valued by the organization, especially considering the different class of patients dealt with in the organization. There is the tendency of nurses leaving the organization even before the five-year period due to the availability of better job offers. The turnover rate is one of the factors affecting the quality of rehabilitative service provided in the organization. The nurse-patient ratio is a parameter assessed in the determination of quality in nursing care (Griffiths et al. 2020). In several instance, a nurse could be overseeing over five patients, resulting in negative workloads. The significance of nurse staffing levels in acute care settings is highlighted in many medical studies. Policy and practice reforms should strive to address the high turnover rate in the organization.
Recommended Policies for Nurse Staffing
The primary policy change required at the detox facility is the nurse recruitment and retention policy. The current one is contributing to the issue of nurse shortages, as it increases workloads and results in poor employee motivation. The first change is to ensure nurses that have worked in the facility for over five years receive permanent employment contracts. The new agreements should include novel terms for negotiating salaries and wages. A seamless interview process, which details work directions and management goals should help maintain a high level of professionalism in the healthcare organization. To make current nurses feel more valued, Yeager and Wisniewski (2017) recommend the establishment of a nurse residency program. Studies indicate there is a direct relationship between residency programs and nurse retention. Nurses in such programs will report of higher satisfaction levels compared to those not engaged in one.
The introduction of a nurse residency program will help address nurse shortages in the long-term. The detox facility employs its short-term five-year contracts to cushion itself from the financial implications of salaries and wages. However, the policy results in the opposite effect as high employee turnovers eventually reduce an organization’s profit margins. Nurse shortages imply the inability to expand medical service to serve more patients. Organizations with an active residency program provide its nurses with additional support and an environment that fosters the creation of healthy work relations, enabling a collaborative culture that improves productivity (Yeager & Wisniewski, 2017). Nurse residency programs establish a sense of community, resulting in nurses feeling valued and in the right place. The overall implication is a continuity of high quality care.
Conclusion
Nurse staffing continues to be a pressing concern in the American healthcare system. Nurse shortages stress the system, resulting in an inability to provide high-quality medical service. Identified in medical literature is the fact that low staffing levels increase in-hospital mortality rates and length of stay, which equally heighten operational costs. However, nurse shortages are not always reflective of poor federal and state policies. Medical organizations are known to have ineffective nurse recruitment and retention policies due to a poor understanding of competing needs. Organizational policies and practices should be based on the demands of the healthcare system and not corporate objectives. The future of the health industry seems bright, meaning managers and leaders involved in nurse recruitment and retention will need to be highly strategic to ensure the establishment and maintenance of a skilled and experienced workforce.
References
Gab Allah, A. R., Elshrief, H. A., & Ageiz, M. H. (2020). Developing strategy: A guide for nurse managers to manage nursing staff’s work-related problems. Nursing Research, 14(3), 178–187. https://doi.org/10.1016/j.anr.2020.07.004
Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., Smith, G. B., Ball, J., & Missed Care Study Group. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474-87. https://doi.org/10.1111/jan.13564.
Griffiths, P., Saville, C., Ball, J., Jones, J., Pattison, N., Monks, T., & Safer Nursing Care Study Group (2020). Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion. International Journal of Nursing Studies, 103, 103487. https://doi.org/10.1016/j.ijnurstu.2019.103487
Lasater, K. B., Aiken, L. H., Sloane, D. M., French, R., Martin, B., Alexander, M., & McHugh, M. D. (2021). Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: An observational study. BMJ Open, 11, e052899. https://doi.org/10.1136/bmjopen-2021-052899
Moloney, W., Fieldes, J., & Jacobs, S. (2020). An integrative review of how healthcare organizations can support hospital nurses to thrive at work. International Journal of Environmental Research and Public Health, 17(23), 8757. https://doi.org/10.3390/ijerph17238757
Needleman, J., Liu, J., Shang, J., Larson, E. L., & Stone, P. W. (2020). Association of registered nurse and nursing support staffing with inpatient hospital mortality. BMJ Quality & Safety, 29, 10-18. http://dx.doi.org/10.1136/bmjqs-2019-009732
Twigg, D. E., Whitehead, L., Doleman, G., & El-Zaemey, S. (2021). The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review. Journal of Advanced Nursing, 77(12), 4599-4611. https://doi.org/10.1111/jan.14909
Yeager, V. A., & Wisniewski, J. M. (2017). Factors that influence the recruitment and retention of nurses in public health agencies. Public Health, 132(5), 556–562. https://doi.org/10.1177/0033354917719704