Critical Analysis Of Shortage Of Nurses, Nurse to Patient Ratios and Skill Mix - Essay Example

Running Head: CRITICAL ANALYSIS OF NURSE SHORTAGE Critical Analysis of Nurse Shortage Name Tutor Date Critical Analysis of Nurse Shortage, Nurse to Patient Ratios and Skill Mix in Acute Care in Clinical Setting Introduction Currently, there is worldwide shortage of nurses and it has evidently it has surpassed a crisis field and it appears not only expected that it will persist at its present pace, but that the gap between patient demands and available nurses will only broaden. The number of available nurses has been declining progressively as compared to the growing number of growing public health requirements. Consequently, this has led to unfavorable ratio between the nurses and the patients and hence long-standing care facilities resulting into retreating the time and, as a result, the quality of the individual care given each patient is affected. Skill mix refers to the mix of posts, grades or work within a certain organization or a professional field. A change to the practice of team-based forms of nursing care has transpired as a response to skill mix variations in acute health care settings (Ellis, 2008). Nurse shortage More and more nurses are required annually since people are always ageing, thus requiring increased health care. One reason why the supply of nursing professionals is overly tight is because many people are opting for other professionals like technology and medical areas such as managed care. This leads to insufficient supply of the nurses which is made worse by the increased demand of their services. Public outcry of the shortage has caused hospitals to raise nursing staffs in a very spirited hiring atmosphere, and while a lot of hospitals made inroads to deal with the shortage through offering sign-on bonuses or support in relocation, additional requirements need to be explored as to how to maintain and keep trained nurses. This shortage needs to be addressed since patients with supplementary acute care require additional nursing care and also the level of nurse care plays a role in the recovery of the patients, with more time with nurses lessening adverse results. Therefore, sufficient level of nursing professionals is important in order to provide quality care to the patients. The increasing demand of nursing services is outdoing the pool of professionals joining nursing field, more so because of the retirement of presently employed nurses and shifting of the nurses from the hospitals to other health care field, industries or even nonemployment. Evidently, the impacts of understaffing nurses within a clinical setting are detrimental. This could lead to rise in mortality rate and patients’ requirements not being met which means some diseases will progress thus further complicating the illness. Many hospital overseers contend that there is nurse shortage which could be a crisis since there are very few nurses to suit the present demand. There are several reasons which could have precipitated shortage of the nurses and this includes poor working conditions like underpayment to the nurses which discourages people form training as being nurses (Wolcott, 2006). Effects of nurses’ shortage Nurse shortage has an impact in the quality of health care given to the patients in that the time the patients spend with the nurses is intrinsically connected to the quality of care the patients obtain. This is clearly shown by the adverse patient outcomes. This is because nurse shortage within a hospital is the leading cause of unanticipated negative patient outcomes, in terms of sentry events. Adequate or increased nursing care per patient reduces hospital stay duration of the patient, decreases rates of urinary track illnesses, and upper gastrointestinal bleeding within medical patients. Furthermore, nurse shortage increases the chances of increased death in patients undergoing surgery and also raises the occurrence of pneumonia in surgical patients. Nurse shortage within a hospital setting leads to increased workload and thus impending quality care delivery. Apparently, rise in the quantity of work to a nurse could lead to increased interruptions when treating or availing health care; this is a major contribution to medical errors among the nurses. Nurses often suffer from exhaustion because of the large workload and stressful work atmosphere leads to decreased patient contentment with care. Shortage of nurses within a hospital leads to extended shifts and compulsory overtime which has the potential of harming the quality of patient care such nurses provide (West, 2002). There has been evidence that longer work hours and exhaustion decreases nurses’ job functioning. The probability of fatigued nurses causing errors rises with longer working hours and with any performance of overtime, irrespective of the duration of the original shift. The probability of overworked nurse making an error is three times higher when a particular shift goes beyond 12.5 hours. These outcomes are predominantly relevant since full time hospital staff nurses who are registered always work longer than the scheduled hours and a good number of nursing shifts in hospitals are longer than 12 hours. Nurse shortage could result in utilization of contingent workers which in turn may decrease the quality of care. Growing use of contingent workers in nursing health field and prevalent dependence on provisional nursing staff is also a risk to the quality of hospital care. Since temporary workers are not familiar with the hospital methodologies as compared to the regular workers, the existence of temporary nurses if repeatedly linked to higher demonstration of poor quality care like therapeutic faults and infections (West, 2002). Causes of nurses’ shortage In most case, nurses are poorly paid and have poor working conditions as compared to some professionals. These are key factors that push nurses from the hospitals. This is indicated by diminishing entrance to nursing profession because some nurses are not satisfied with the current working condition within hospitals. There have been research findings that nurse job satisfaction within the clinical set up is very low, whereby the experienced and old nurses are more dissatisfied when compared to the young nurses (Wolcott, 1994). Furthermore, most of the nurses are in a position to get well paying jobs as well as preferable job schedules in professionals outside nursing. Most of the nurses who are not in the nursing professional and working in some other field are in big positions with higher salaries. Another reason leading to shortage of the nurses is because many people view clinical setting employment as very demanding when compared to other health care areas. Moreover, the work schedules offered in other places are viewed as more attractive. Poor working conditions and insufficient benefit policies and short of profession ladders within clinical nursing also make other employment opportunities more striking. With time, there have been great changes in the delivery of health care and thus increased demand and hospital perception. Generally, demand for nursing health care is rising. This could be attributed to the population ageing, with the ageing population moving into groups that require increased medical care. Still, patients are gradually becoming more aware of medical practices and more aggressive in seeking medical care more so the care requiring concentrated support from the nurses like investigative procedures, surgeries and transplants (Ellis, 2008). Managing nurses’ shortage Increased pay for the nurses is the most obvious way of drawing both presently qualified nurses and would-be nurses within clinical setting. This is demonstrated in hospitals that pay the nurses well since they get more nurses hence sufficient staffing and consequently improved quality of health care provided. Still, this would prevent the nurses from moving to other professionals. Again, high payment to nurses will lead to extension of nursing education and this would avail enough nurses currently and in future. If sufficient research and increased public education is done to assist the hospitals, administrators and public on the effects of pay to both nurses and patients, this would assist in a way. When the pay is raised, the supply of nurses is likely to increase and thus hospitals will be in a position to solve their staffing issues without understaffing the hospitals or overloading the nurses. Hospitals ought to improve the nurses’ salaries and working conditions to improve patient outcome since the patient’s medical requirements will be handled by proficient, concerned nursing staff (Ellis, 2008). Nurse to patient ratios Normally, charge nurses and administrators are not computed in nurse to patient ratio. Hospitals should have sufficient staffing basing on patient acuity for a suitable nurse to patient ratio to occur. Increasing demand of clinical nursing services has led to increased workload to the nurses. The increased workload leads to decrease in the number of nurse per patient. As a result, there is increased risk to both nurses and patients. A recent research indicates that if the optimal workload for a nurse is four patients and the workload is raised to six patients, fourteen percent of these patients have a possibility of dying within 30 days after they are admitted. A workload of eight patients to one nurse increased the mortality with thirty percent. In addition, increased number of nurses led to reduction of urinary track infections, pneumonia and infections during major surgeries. Moreover, decreased nurse to patient ratio illustrates low level of registered nurses within a clinical setting. Staffing a hospital with few registered nurses has been found to be a major cause of increasing nurses’ risk to needle prick injuries. Example: Nurse to patient ratios according to acuity of care, size and location Category of Unit Hospital grouping a.m. shift p.m. shift General Medical/Surgical Ward Level 1 1:4 + in charge 1:4 + in charge   Level 3 1:5 + in charge 1:6 + in charge Ante/Postnatal Every level 1:5 + in charge 1:6 + in charge Operating Theatre 3 nurses for each theatre Post Anesthetic Care Unit / Recovery Room Every shift 1:1 for patients who are not conscious. (West, 2002) Appropriate nurse to patient ratio lays down a safety net to both patients and nurses. The benefits that come with appropriate nurse to patient ratio include safer atmosphere for the patients and that nurses are able to go back to the bedside work of their occupation without being pushed. Besides, it makes it easier for the nurses to gather relevant information in the clinical system. Proper nurse to patient ratio indicates safe and ample staffing level within a hospital. As a patient safety intercession, patient-to-nurse ratios of 4:1 are realistically economical and in the range of other universally acknowledged interventions (Wolcott, 2006). Higher nurse to patient ratio leads to better patient outcomes. This is because raised number of nurses per in-patient gay leads to reduction of preventable bad events like urinary track infections, pneumonia and several infections occurring after surgery like thrombosis. Patients receiving intensive care stay longer in the intensive care unit incase nurse to patient ratio decreases thus lengthening their hospital stay period. Nurse to patient ratio is also associated with patient mortality. Actually, every extra patient per registered nurse raises the probability of the patient dying in 30 days after being admitted by 7% while every added nurse patient reduces the chances of AIDS patient dying within 30 days after being admitted by more than 50% (Erlandson, 2003). Skill mix in acute care in clinical setting Skill mix can be a mix of the qualified and non-qualified in the nursing. Skill mix within a clinical setting or in a hospital is noteworthy. Higher number of qualified nurses in comparison to other hospital workers improves quality of care to the patients. This is mostly illustrated by medication errors. For example, if the number of nurses is higher in a given hospital setting, there would be decreased infection of wounds, decreased patient falls, reduced patients’ stay in the hospital and also reduced occurrences of incidences like shock and cardiac arrests. According to Erlandson (1993), a 10% rise in nurse labor hours reduces the chances of pneumonia incidences by 9.5% as proportion of the entire hospital nursing hours. Yet again, the percentage of nurses who are registered within a hospital has also been found have an influence on the probability of patient dying. There are also concerns that this mix undermines the qualification and skills of the qualified nurses (NSW Health Office of Nursing and Midwifery 2006). However, the mix of nurse personnel whereby there is increased number of less skilled staff will not be effective always in a hospital setting. The doctor–nurse overlap illustrates that there is unrealized range in various systems for expanding the use of nursing staff. When skill mix occurs in a clinical setting, activities and skills required to provide nursing care could be combined (Lincoln, 2005). Skill mix is evaluated basing on the necessity to recognize the care requirements of a precise patient population and then harmonizing these to the skills of the available staff. There are various shortcomings of skill mix and this includes more expenses since there are numerous costs related to skill dilution. This is because there is elevated absence and turnover rates of the staff that is not fully qualified due to increased level of unproductive time since care assistants have low independence and ability to operate independently. However, the main concern is that the care assistants could harm the patients if they work beyond their technical ability (NSW Health Office of Nursing and Midwifery, 2006). Conclusion Shortage of the nurses automatically leads to increased work load to the nurses. Increased nurse workloads are as a result of burnout, occupation frustration, antecedents to voluntary proceeds which take part in understaffing of nurses within hospitals and poorer patient results. Nurse shortage and their overworking within hospitals is a major danger to patient’s safety. Apparently, improved working conditions have the ability of decreasing the nurses' high levels of job burnout and threat of turnover and amplify patients' contentment with their care. Finally, sufficient nurse staffing and administrative support to the nurses is the key to improving the value of patient care, to decreasing nurse job dissatisfaction and overload and to improving the nurse maintenance predicament in hospital settings (Lincoln, E. 2005). . References Ellis, J. (2008) Nursing in today's world: Trends, issues and management. Williams & Wilkins: Philadelphia. Erlandson, D. (2003) Doing naturalistic inquiry: A guide to methods. Sage: Newbury Park CA. Lincoln, E. (2005) Naturalistic inquiry. Sage: Beverley Hills CA. NSW Health Office of Nursing and Midwifery. (2006). First report on models of care. NSW Health: North Sydney. West, M. (2002). The effectiveness of health care teams in the National Health Service. University of Leeds: London. Wolcott, F. (2006) Transforming qualitative data: Description, analysis and interpretation. SAGE: Thousand Oaks. Read More