A common misconception in the healthcare industry is that doctors and other specialized physicians are the pinnacles of most healthcare teams. While one can argue the truth in that perception, nurses are often overlooked. Patient safety is a critical component of any healthcare system, and nurses play a significant role in ensuring that patients receive quality care services. Amiri et al. (2019) believe that doctors and other specialists spend little time with critically ill patients, whereas nurses are always present, looking after the patient's needs, communicating with family and friends, and interact with other physicians. Therefore, among other health coordination team members, nurses play a central role in promoting patient safety and outcomes by monitoring their treatment progress, reporting any arising complications, and engaging in other patient-related activities. However, most healthcare systems fail to acknowledge the growing challenge of heavy nurse workload. This paper addresses critical issues in nursing workload, critiquing policies influencing this challenge, and recommending changes to balance nursing workload.
Competing Needs Impacting Nursing Workload
Nurses` work rate and vigilance are critical to their capacity to foster patient safety and outcomes. According to Brooks Carthon et al. (2019), increasing nursing roles and patient needs significantly compromise their ability to provide care services to patients. As patient numbers increase, each nurse is assigned more patients than they could manage simultaneously. Apart from patient safety, increased nursing workload adversely affects job satisfaction and nursing turnover. With higher patient acuity, nurses must perform other tasks not related to their professional resumes, such as removing trays from patient rooms and other housekeeping duties. Resolving the nurse staffing issue has been a challenge for many healthcare facilities as they have to consider the availability of nurses, patient turnover, and the skill set among the nursing staff.
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Nursing working conditions is another competing need that affects nurses` workload. In the current context, unproportioned nurse-to-patient ratios increase the nurses` risk of burnout and dissatisfaction in the workplace. According to White et al. (2019), overworking nurses result in missed nursing care, common in many inpatient wards. Burnout among nurses also jeopardizes patient safety, indicating an increasing nurse workload will propel them to make costly yet straightforward mistakes while undertaking their routine duties.
Relevant Policy or Practice that Influences Nurses` Workload
The nurse-patient ratio has been an effective policy implementation that is applied across many healthcare facilities. In most states, hospitals must assign a minimum number of patients to each nurse, ensuring that nurse staffing is controlled and manageable. A balanced nurse-patient ratio brings significant benefits for both the nurses, patients, and healthcare in general. For instance, when nurses care for few patients per shift, job satisfaction, and patient safety are guaranteed (Brooks Carthon et al., 2019). Moreover, the quality of patient care significantly increases when healthcare facilities balance out issues in nurse staffing. The above strengths are a testament to hospitals employing better nurse-patient ratios that match their patient inflows.
However, increasing patient needs have also led to a demand for more nurses. Currently, a shortage of nurse staffing in most healthcare facilities continue to burden the healthcare system. Despite there being standardized nurse-patient ratios in most regions, hospitals can face a sudden increase in patients, stretching the nurse-patient ratio. Under such scenarios, nurses overwork to meet the increased patient demand, impacting patient safety, and outcomes. White et al. (2019) are critical of increased nurses` workload under these circumstances, acknowledging that nurses develop emotional distress, dissatisfaction, and stress. As such, the nurse-patient ratios do not compensate for an influx of patients, overburdening the nurses and healthcare facility in the process.
Ethical Considerations of the Nurse-Patient Ratio Policy
As a significant healthcare challenge, the nurse staffing shortage across the U.S has significantly impacted the values and beliefs people perceive in healthcare. Nurses are obliged to ensure that patient safety and outcomes are achieved. However, understaffing has forced nurses to abandon these ethical obligations towards their patients and the nursing practice. One ethical consideration nurses are obliged to perform is providing quality patient care. Nurses are required to protect the patients while attending to them. However, since the nurse-patient ratios do not account for the increasing patient numbers, these nurses are assigned more patients than they could manage. As a result, patient care becomes poor and risk-prone (Senek et al., 2020). For instance, chronic patients mandate quality care and emotional support. Inadequate nurse-patient ratios can significantly impact their recovery process.
Ethics in nursing are critical in the decision-making process. Through the right morals, nurses can make the right decisions while providing care services to patients. As increased nurse workload leads to job dissatisfaction, nurses do not feel obliged to carry out their duties. Responding to this menace, hospitals pay nurses for overtime work. However, this incentive only solves the technical part of the problem, leaving out moral distress and burnout. The lack of ethics of work and job dissatisfaction results from an unconducive workplace environment, and Senek et al. (2020) note that moral distress impacts the nurses` inability to undertake their moral obligations within the healthcare facility. When an individual nurse is assigned more patients than they should handle, it affects their ethical responsibility to prevent harm to patients or provide poor patient care.
Recommendations for Policy Change
Healthcare facilities continue to look for better approaches to reducing operational costs while improving efficiency. Since nurses make up the highest percentage of hospital staff, inappropriate nurse-patient ratios still left hospitals understaffed. Traditional methods for setting the nurse-patient ratios do not account for changing variables within healthcare. Healthcare facilities are being encouraged to adopt new staffing models that allow for flexibility and foster adjustments to fit individual units. One change hospital can undertake is shifting towards a more formal staffing plan that ensures each patient is matched with the most appropriate nurse who possesses the required skillset (Amiri et al., 2019). Additionally, addressing the underlying issues surrounding nurse staffing is critical to strengthening the nurse-patient ratios. Improving workflow can result from adopting modern technologies in the workplace, reducing mandatory overtime, and assigning duties to other qualified staff in the healthcare facility (Morley et al., 2019). Above all, consulting the nurses on ways to perfect the nurse-patient ratio is another step towards reducing nurse workload.
Conclusion
Ultimately, nurses are obliged to promote nursing ethics and use their moral values to make the right decisions. Nurse workload has been an underlying issue in the healthcare sector, impacting job satisfaction, patient care, and outcomes. While most healthcare facilities have adopted the nurse-patient ratio metrics in resolving nurse understaffing, the issue has continued to impact service delivery. This nursing practice is ineffective because it cannot account for increased patient numbers and demand for more qualified nurses. At the same time, job dissatisfaction, emotional distress, and burnout continue to impact nurses and their ethical obligation in fostering patient safety. Therefore, hospitals must consult their nurses, adopt a formal nursing plan, and resolve any underlying nurse staffing issues to address the nurses` workload problem adequately.
References
Amiri, A., Solankallio-Vahteri, T., & Tuomi, S. (2019). Role of nurses in improving patient safety: Evidence from surgical complications in 21 countries. International Journal of Nursing Sciences , 6 (3), 239-246. https://doi.org/10.1016/j.ijnss.2019.05.003
Brooks Carthon, J. M., Hatfield, L., Plover, C., Dierkes, A., Davis, L., Hedgeland, T., Sanders, A. M., Visco, F., Holland, S., Ballinghoff, J., Del Guidice, M., & Aiken, L. H. (2019). Association of nurse engagement and nurse staffing on patient safety. Journal of Nursing Care Quality , 34 (1), 40-46. https://doi.org/10.1097/ncq.0000000000000334
Morley, G., Ives, J., & Bradbury-Jones, C. (2019). Moral distress and austerity: An avoidable ethical challenge in healthcare. Health Care Analysis , 27 (3), 185-201. https://doi.org/10.1007/s10728-019-00376-8
Senek, M., ROBERTSON, S., RYAN, T., RN, R. K., WOOD, E., & TOD, A. (2020). The association between care left undone and temporary nursing staff ratios in acute settings: A cross- sectional survey of registered nurses. https://doi.org/10.21203/rs.2.22471/v2
White, E. M., Aiken, L. H., & McHugh, M. D. (2019). Registered nurse burnout, job dissatisfaction, and missed care in nursing homes. Journal of the American Geriatrics Society , 67 (10), 2065-2071. https://doi.org/10.1111/jgs.16051
