The heavy workload experienced by nursing is a significant issue in the American healthcare issue. Four critical reasons have led to the increased workload on the nurses. One is the increased demand for nurses and secondly, the shortage of the nurses. Increased overtime and reduced staffing also lead to the increased overload, and lastly, the reduction in the patient's length of stay also influences the problem (Abukhader, 2012). Heavy workload among the nurses leads to workload disparity where some nurses especially the junior nurses are left with the bulk of the work and others have relatively less work. It is critical to note that workload issues have considerable effects on the nurse and the patients in equal measures. Whereas the nurses might report fatigue, poor quality of work, and increased levels of stress, the patients, on the other hand, will suffer from these effects thereby failing to improve their outcome. The role of a nursing manager is to ensure that workload is distributed well among the nurses. It is the responsibility of the nursing manager to formulate and explore several strategies that he or she can use to combat the issue of workload disparity.
Legal and Ethical Issues
As a manager, the first ethical issue that I would explore in a scenario where the workload disparity prevails is ''working with limited resources.'' The role of the nurses is to take care of many sick people, and in some cases, they are forced to use a limited the number of staff they have. The nurses have to strike a balance between containing costs and considering clinical implications that might arise. Coventry et al . (2015) asserted that the nurses who suffer from a workload disparity have to choose whether they remain the advocates of the clients or look out for the economic interests of the healthcare. The codes of ethics of nurses are also vocal about the fundamental values that dictate the nursing profession. Some of the values outlined in the code of ethics include fairness, accountability, and practice environments that are enabling to safe and competent care among others. The disparity in workload jeopardizes the fairness in both the nursing practice and the provision of quality healthcare. Nurses who will be left with heavy work to do will feel unfairly treated. According to Martin (2015), those with relatively lesser work will give the much-needed attention to the patients thereby improving their health outcomes in comparison to those attended to with overwhelmed nursing officers. Therefore, this will lead to disparity in outcomes which negates on the principle of fairness advocated in the codes of ethics.
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Moral distress is another ethical issue that can arise from a situation of workload disparity among the nurses. Moral distress will result from the feeling that they jeopardize their moral responsibility of protecting patients from harm by giving the patients inadequate care. It is important to note that among the ethical considerations of the nurse is to prevent the patients from any source of harm. However, when a huge number of patients are given to specific nurses, it results in the compromise of the patient and nurse's welfare. In such situations, the overwhelmed nurses can only fix themselves by performing basic procedures such as injection that have little significance on the welfare of the patient. In worse cases, the nurses can perform medical results that result in adverse healthcare outcomes and even death.
One of the most critical legal issues that surround the matter of disparity in workload is concerned with labor unions. Labor unions act as an intermediary between the management and the employees. It helps in giving the nurses a voice against the management and ensures that they work in a conducive environment. Nurses who feel that they are victims of workload disparities can seek the assistance of labor unions which can help them in seeking legal address on the matter by giving them necessary advice and also hiring them a lawyer if they cannot afford one. Another legal implication that is important in the matter of massive workload is understaffing. However, it is important to note that the public can trigger lawsuits against healthcare facilities on the issue of understaffing. The hospitals and individual nurses can also be charged with negligence in their duty that is as a result of understaffing. Failure of care on the same grounds can also be used to pursue criminal and civil prosecution by the public. In such lawsuits, the plaintiff can sue a healthcare facility for poor nursing practices that lead to injuries, residents wandering, bedsores, and in some cases, death.
Investigating the Complain
As the manager, I will ensure that the investigation involves gathering necessary information and evidence to prove that workload disparity exists among the nurses and any other possible effects on the nurses and patients. As such, the investigation will include obtaining relevant information and documents, interviewing anyone I believe has the necessary information, and thirdly, seeking a clinical opinion that is independent. Since this is a serious allegation that might have negative impacts on the healthcare facility, I would ensure that the investigation timeframe is limited to a short period, probably for 60 days. I will also ensure that after every ten days I report my progress to the necessary stakeholders before coming up with a comprehensive report on the matter. My preferred data collection plan will include interviewing a selected group of nurses, giving the nurses questionnaires to fill regarding the issue of work, and observation where I would personally analyze the distribution of work among the nurses.
After data collection, I would organize a team of experts to assist me in the analysis where they would subsequently prepare a report. The report will contain comments, information, and the recommendations relating to the case. I would also share the report with relevant parties such as the complainant, health service providers, and the health department among other key stakeholders. I would also consider making the final report public to solicit help if I deduce that the cause of the workload disparity is understaffing. I would then report recommendations and begin the implementation process.
Orientation, Performance Appraisal, and Team Building
The primary goal of orientation in nursing is to ascertain that the orienteers receive vital and consistent information regarding policies, standards, procedures, and standards that are in line with the mission, vision, values, and goals of the organizational structure. In this scenario, the nursing objective could be geared towards creatively using the existing workforce to meet the patients' healthcare demands and achieve the desired results. Mosadeghrad (2013) asserted that the orientation process would also be important in ensuring that every nurse understands their job specifications, nature of work, and how well they can collaborate to prevent the onset of disparities in the workload. The effective orientation of the nurses should focus on reducing the disparities in the distribution of work by incorporation where the new members are included in the day to day duties as early as possible after a thorough definition of the roles and expectations. As a nurse manager, it is also important to make sure that the orientation becomes an ongoing process where staff members can continuously be reminded of their job expectations to avoid future cases of disparity in workload that might lead to burnout.
Performance appraisal is a continuous, consultative, and a participative process conducted by the nursing manager to assess the strength and weaknesses of both the current and recent performance in the hospital organization. It attempts to assess the performance of the workers with regards to the goals and objectives of a job for a given period. Performance appraisal is essential for reasons such as identifying the strengths and weaknesses of employees, identifying individuals for promotion, enhance career progression, and recognizing good work. Also, through performance appraisal, disparities in the distribution of workforce can also be easily detected. It would also improve job satisfaction and motivation among the nursing staff. Most importantly enough, it would alter to managers any constraints which can act to inhibit employee performance.
Another important factor that might serve to reduce workforce disparity in a healthcare system is team building. Masters (2015) pointed out that it involves taking a collaborative approach to tackling various medical problems. In such a setting, the nurses will be keen to respect their differences and prime themselves for positive thoughts. Team building will also demand that nurses recognize and acknowledge co-workers and offer them encouragement and praise accordingly. Nurses will also be encouraged to offer a helping hand to their counterparts who are in dire need of help. Nurses should always accept their mistakes and work towards correcting them.
In conclusion, understaffing is the major cause of workload disparity in the healthcare setting. It is proven that this type of disparity has negative effects on both the welfare of the nurses and the outcome of the patient. It is the role of a nursing manager to understand the ethical and legal implications of such an issue and carry out investigations that are geared towards remedying the situation. It is also critical to understand that employee orientation, performance appraisal, and team building are all important steps that can improve the workload disparity in the face of limited human resources.
References
Abukhader, S. M. (2012). Measuring nurse performance: A systems perspective. International Journal of Healthcare Management , 5 (3), 117-128. doi:10.1179/2047971912Y.0000000011
Coventry, T. H., Maslin‐Prothero, S. E., & Smith, G. (2015). Organizational impact of nurse supply and workload on nurses continuing professional development opportunities: an integrative review. Journal of advanced nursing , 71 (12), 2715-2727.
Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing , 24 (2), 4-6.
Masters, K. (2015). Role development in professional nursing practice . Jones & Bartlett Publishers.
Mosadeghrad, A. M. (2013). Occupational stress and turnover intention: implications for nursing management. International journal of health policy and management , 1 (2), 169.
