The shortage of nurses in hospitals is a major challenge that is affecting the healthcare industry both in the short and long-term basis. Registered Nurses (RNs) are the largest healthcare professionals group in the United States (US). Despite this, their demand is continually growing and according to the Bureau of Labor Statistics (2018), employment of RNs will grow by 15% between 2016 and 2026. There are various reasons that attribute to the shortage of nurses like a growing population, the increase of healthcare access by the Affordable Care Act (ACA) and an increase in older patients in need rigorous healthcare services. These issues result in ripple effects on the nursing staff and patients and an unsustainable nurse to patient ratio. The multifaceted effects are continually raising questions about the safe staffing policies that different hospitals and states employ. Additionally, such working conditions of the RNs affect and result in ineffective patient care. This project will focus on the challenges of the nursing shortage, the nurse-patient ratio and the effects it has on the nursing staff and patients.
Literature Review
The research material and original resources were a result of reviewing different journal and peer-reviewed articles in the US. The researcher used the CINAHL, NCBI, and MEDLINE databases to acquire this information. The strategy used was by typing particular terms like nurse shortages, nurse to patient ratios in the state of New York and the US and the overall effects of RNs’ shortage in the healthcare industry. All these information ensured that the related parties, patients and nurses are inclusive in order to broaden the scope. The references clearly indicate their sources and offer links for retrieval.
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The first source used was Aiken, L. H., Clarke, S. P., Sloane, D. M., et al (2002, October 23). “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction.” This article is critical in discussing the effects of nurse shortages, how it relates to the effects of nurses burnout. Additionally, the authors articulate the correlation between the nurse-patient ratio and the overall patient mortality in different scenarios. The preference of this article over others is because RNs shortage is a vital concept that has roots over decades without possibly effective solutions. According to Aiken, et al, reports by nurses nationwide indicate that staffing levels in hospitals are insufficient in providing effective and safe care (2002).
The second source was Lang, T., Hodge, M., Olson, V., Romano, P., & Kravitz, R. (2004). “Nurse-Patient Ratios: A Systematic Review of the Effects of Nurse Staffing on Patient, Nurse Employee, and Hospital Outcomes.” This article’s objective was to determine if other peer-reviewed texts found particular acuity in the nurse to patient ratio. This is an important piece of literature as it determines and sources information from other peer-reviewed journals on the efficacy and relationships of the patient, nurses and hospital outcomes. In this regard, this information is vital in addressing the results, conclusions and possible solutions from other academic staff on how the government and hospitals can aid in solving this prevalent problem. These studies are also critical in addressing how more nurses help reduce shorter hospital stays and lower infection rates in acute care facilities.
The final source is Keenan, P. (2003). “The Nursing Workforce Shortage: Causes, Consequences, Proposed Solutions.” The reason for choosing this article brief is because it offers recommendations and strategies for dealing with the RNs shortage. This is an important viewpoint since it allows this research to offer possible solutions that help in improving the healthcare industry. Additionally, there are recommendations regarding how the federal, state and private actions like the executive branch and non-governmental organizations can contribute to alleviating this thorny issue in order to improve safe and responsible patient care. For example, according to Keenan (2003), ideas of taking precedence from the state of California might help in improving the nurse-patient ratio.
Connections
The resources used for this research project are crucial in understanding and discussing the challenges of the nursing shortage, the nurse-patient ratio, and the effects it has on the nursing staff and patients (Keenan, 2003; Lang et al, 2004; Aiken et al, 2002). The effects of the shortage of RNs in hospitals affect the overall healthcare industry. In terms of proper and safe patient care, there are challenges that need addressing. Some of these challenges include complications and infections acquired in the hospital facilities because of overworked nurses (Lang et al, 2004). The other challenge regards to the problem of nurse-patient ratios. According to Aiken, et al (2002), there is a correlation between patient mortality and deaths that result from complications especially during surgical procedures due to the limited number of RNs. RNs are responsible for taking care of the patients during or after medical procedures. Therefore, if the nurses are overworking due to more patient visits, it would result in nurses burning out and causing errors and inefficient service provision to patients. However, there are proposed strategies that need implementation from the relevant authorities like the federal, state and private action organizations (Keenan, 2003).
The RNs shortage has legal issues that hinder the proficient patient safety and care. Hospitals with low staffing levels continually receive lawsuits against them. These events normally occur especially when a patient acquires infections that they relate to poor service delivery and safety measures by the healthcare professionals. However, with the culmination of the Nurse Licensure Compact (NLC), RNs can practice in any of the 25 states around the country. The expansion of the compact enables patients to access the best medical care available without worrying about getting infected or staying longer in hospitals due to complications and neglect from the staff.
Additionally, there are ethical issues that revolve around low staff levels and RNs shortages. For example, beneficence advocates for taking actions that would not harm others. In this regard, RNs find it difficult to remain ethical since at times they have to handle more patients than required. In this case, neglect is certainly leading to patient complications. Additionally, the principle of non-maleficence means that one should do no harm to their patients. However, it is complicated when a nurse has burned out and neglects to attend to a particular patient because of low staffing levels. Another consideration of an ethical concept is that of autonomy. RNs have a limited scope to where and when they can make appropriate decisions with the heavy workloads. This deficit alternately leads to job dissatisfaction and poor provision of medical care to the patients. All these issues disregard the American Nurses Association’s (ANA) codes. With limited resources, staffing issues and heavy workloads, it is difficult to attend and maintain these codes of ethics.
Relevance
The focus on the challenges of the nursing shortage, the nurse-patient ratio and the effects it has on the nursing staff and patients is critical in finding a solution to the projected health issues and demographic changes. According to Keenan, the ageing population of the baby boomers era is growing and their needs are growing (2003). This example is just one of the many health concerns facing the healthcare industry and systems. Therefore, there are requirements that need attention and that is why the focus on RNs shortage is critical to delivering quality health and wellbeing. These challenges are a national issue and affect how hospitals and health care professionals administer health services. As noted, the RNs are the largest group of professionals in the health industry. Therefore, it is important to make sure that there is an adequate number of resources to accommodate the rising concerns. Another example is the fact that the ACA increased the number of people that can access health services (Aiken, et al, 2002).
Additionally, studying the effects of safe patient care and RNs shortage will provide a discourse that emphasizes on regulating the nurse to patient ratio. For example, due to staffing issues and unsafe working methods by the RNs, the rise of infections and other medical issues like deaths, is prevalent (Snavely, 2016). Reports and lawsuits emanating from staffing shortages are a clear indication that hospitals and the American public pay a high cost from incidents of deaths and longer patient admissions in the estimates of $68 billion (Lang et al, 2004). Therefore, this is a perfect indication that there is a consistent hindrance to the provision of adequate health services.
Theoretical Foundations
In the nursing profession, four major fields link the nursing theories and models. These domains are the environment, the client, health and nursing. These spheres allow the nurses to know why and what they are doing in order to acquire knowledge. In this project topic, the concentration is on Jean Watson’s theory of human caring. This philosophy maintains that nursing involves the promotion of health, averting illnesses, caring for the sick and promoting health (ANS, 1978). It is crucial to note that this theory argues that caring is significant in the nursing profession in order to restore health as well as treating ailments. One of the major concepts of this theory relates to the nursing profession as a relationship between people and their overall health. It also accommodates assumptions that detail the presence of an effective care strategy and a caring environment that promotes well-being (ANS, 1978). This fact is crucial to this topic because, with a shortage of RNs in the hospital environment, it is difficult for patients to receive the adequate care that they deserve. Therefore, to create an interpersonal relationship between the nurse and the patient, there is need of sufficient time and resources to administer the right care.
The alternate theory in use in this project is the modeling and role modeling theory by Kelley Sappington. This theory allows the nurse to model the client’s world by understanding and appreciating its value and importance. On the other hand, the nurse role models the client by nurturing and caring for them to promote their health (Sappington, 1996). This theory clearly indicates the importance of the nurse’s role. However, with low staffing and RNs nurses continually reporting of burnouts, it is impossible to give this much attention to individual patients or families.
Concluding Reflection
In my opinion, this research topic has had a great impact on my knowledge and practice as a registered nurse. The inefficiencies that result from understaffed hospitals is immense and needs strategies that would aid in easier and safer working environments. I believe that the research in consideration brings out a clear picture of what the situation is on the ground.
Essentially, it highlights the challenges that RNs face in their day-to-day activities trying to provide sufficient and appropriate health services. The fact that these issues are decades old is a clear indication of the lackluster initiatives that the responsible bodies and organizations have towards the nursing profession. However, I have realized that through the NLC, there are different states to source better working environments.
Conclusion
The shortage of nurses, nurse-patient ratio, and the effects it has on the nursing staff and patients is a dreadful to the overall healthcare industry. It is difficult to offer proper and efficient health services with such challenges. This situation explains the reasons for the reports of high rises in acquired infections by patients while in hospital facilities. Therefore, intervention measures and strategies from all stakeholders is paramount to reduce the deaths. Additionally, with future needs of more intensive medical attention of the elderly and heavy workloads on the RNs, possible solutions like evaluating the nurse to patient ratio is crucial. Long-term quality care of the population is vital to the growth of the American society.
References
Aiken, L. H., Clarke, S. P., & Sloane, D. M. (2002, October 23). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. 288 (16):1987-93.
ANS, Advances in nursing science. (1978). Frederick, Md. Etc.: Aspen Systems Corp . Retrieved 21 Apr. 2018 from, http://umassboston.worldcat.org/title/ans-advances-in-nursing-science/oclc/4064666
“ Summary.” U.S. Bureau of Labor Statistics , U.S. Bureau of Labor Statistics, Retrieved 21 Apr. 2018 from, www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm.
Keenan, P. (2003). The Nursing Workforce Shortage: Causes, Consequences, Proposed Solutions. The Commonwealth Fund . (619):1-8.
Lang, T., Hodge, M., Olson, V., Romano, P., & Kravitz, R. (2004). Nurse-Patient Ratios: A Systematic Review on the Effects of Nurse Staffing on Patient, Nurse Employee, and Hospital Outcomes. The Journal of Nursing Administration . 34 (7-8):326-37.
Sappington J, K. (1996). Modeling and role-modeling theory: a case study of holistic care. J Holist Nurs . 14 (2):130-41.
Snavely, T. M. (2016). A brief economic analysis of the looming nursing shortage in the United States. Nursing Economic . 34 (2):98-100.
