Budgets Cuts and Nursing Staffing - Essay Example

?Running head: BUDGET CUTS AND NURSING STAFFING The effects of budget cuts on nurse-staffing and the quality of care in hospitals (school) Theeffects of budget cuts on nurse-staffing and the quality of care in hospitals Introduction The global economic crisis is impacting on almost all aspects of our lives, including our health care system. This crisis is prompting various adjustments in the health care delivery system, adjustments which translate to budget cuts and other health economic plans like health care rationing and health care rationalization. This paper shall discuss the impact of budget cuts on nurse-staffing and on the quality of care in hospitals. It shall discuss the economic crisis and budget cuts in terms of their ability to impact negatively in the general health care delivery of patients and of hospitals. Discussion Due to the protracted and still lingering economic crisis, legislators and other administrators have implemented budget cuts in the health care sector. These budget cuts have affected all aspects of health delivery, from staffing ratios, salaries of staff, to the purchase of equipment and hospital supplies. In terms of nursing staff, budget cuts have translated to fewer nurses being hired and lower pay for nurses hired; it also translates to nurses caring for an overwhelming number of patients – more than they can safely and adequately care for. The application of financial management the resolution of the health care issue in this case has gone through the stages of planning, controlling, organizing, and finally decision-making (Baker and Baker, 2011). It is unfortunate to note how the health financing process has resulted to budget cuts in health care and in this case, in the nursing profession. Inadequate nursing staff caring for an overwhelming number of patients is one of the major contributory factors to nursing burnout, and such burnout often leads to medical errors in the practice. There seems to be an agreed consensus on the relationship between nurse staffing and improved patient outcomes. In other words, with higher patient staffing levels, better patient outcomes seem to be more apparent (Garrett, 2008). The Agency for Healthcare Research and Quality sets forth that nursing burnout can often compromise health care services. Chronic fatigue, as well as limited sleep and lack of rested sleep are common issues among nurses and other health personnel. In the documented case of Julie Thao, accounts reveal that she worked two 16 hour shifts back to back and at one point fell asleep at a hospital cot. Upon awaking, she administered the wrong medicine to a patient. Unfortunately, this led to her patient’s death (Garrett, 2008). She pled no contest to criminal neglect and was sent to jail for such neglect. Human errors impacts significantly on medical care (Kane, et.al., 2007). Not many studies have been carried out on the relationship of fatigue and on the decreased quality of health care. Studies in other fields of practice however exemplify how fatigue can slow down reaction time, how it can cause omissions, reduce problem solving ability, decrease motivation, and reduce a worker’s energy for assigned tasks (Garrett, 2008). Fatigue has been seen as the cause of errors in construction workplaces, oil fields, and even on airplanes (due to sleeping or exhausted traffic controllers). It is not therefore a far-fetched idea for such fatigue to translate to medical errors. Even if studies on this issue are limited, such errors have been accepted as possible eventualities by overworked medical and nursing practitioners themselves. Budget cuts in nursing cause fewer nurses to be hired. This means shortage of staff to fill in patient needs in the hospitals. In order to resolve this problem, hospital administrators are often prompted to impose mandatory overtime among their employees. Such overtime is often required during unplanned and emergency procedures in the clinical setting (Buerhaus, et.al., 2007). Shift changes which do not yield available relief nurses often prompts the current duty nurses to render overtime. Such mandatory work times can often lead to chronic fatigue and reduced quality of sleep and rest. Studies reveal how overtime leads to burnout and absenteeism, as well as job dissatisfaction among nurses (Buerhaus, et.al., 2007). Moreover, overtime work has often led to medication errors – with wrong patients, wrong dose, wrong preparation, or even wrong medicine (Mystakidou, et.al., 2007). Budget cuts impact on nurse staffing in hospitals in the sense that it reduces the quality of nursing care. The remaining nurses on staff are often prompted to carry out multiple tasks and to serve multiple patients with hardly any rest between tasks during their shifts. This causes fatigue among these overworked nurses; such fatigue has been known to cause feelings of dissatisfaction and burnout (Poncet, et.al., 2007). Studies also reveal that extended 12 hour shifts can often cause injuries and automobile accidents among nurses; chronic fatigue has also been known to cause depression (Kane, et.al., 2007). The fact that working more than 40 hours a week is an accepted norm among nurses implies how the practice is different from other professions. This practice is however a dangerous trend in the nursing profession because according to studies, after 17 hours without sleep, people’s general performance acquires qualities of alcohol levels at 0.05% and after 24 hours without sleep, alcohol levels at 0.10% (Garrett, 2008). And yet, due to budget cuts, many nurses are often asked to be on call to fill in additional hours of work, ranging from as short as 30 minutes to as long as full eight hour shifts. These nurses also have to fill in their regular shifts aside from their overtime and on-call shifts. Such hours of work affect the nurses’ rest and sleep patterns. Fatigue often sets in for these nurses with this pattern of work, compromising the quality of the nursing care and reducing their productivity in the health care setting. Some studies point out that there is an apparent relationship between medical errors and hours worked by nurses. In a paper by Bellebaum (2008), the author set out to establish the relationship between nurses’ work hours, fatigue, and the occurrence of medication administration mistakes. The study was carried out as a non-blinded, observational-based study at am academic medical center in Columbus, Ohio. The administration of medications was observed in three shifts assessing about 500 administrations among 30 MICU nurses. The study established that dose errors were the most common issues encountered in the administration of medications. Preparation-based errors as well as time administration errors were also encountered (Bellebaum, 2008). The study also revealed that the longer the nurses spent in their work, the more likely they were to commit the following errors or omissions in the practice: not check patient’s armband, not double-checking medication order, and not washing hands (Bellebaum, 2008). Assessment of the data indicates that work hours of nurses impact on the occurrence of errors in nursing care, most especially in terms of medication administration. Budget cuts in health care have also impacted on the nursing practice in terms of nurse-patient ratios with nurses caring for more patients than they are legally or even professional mandated to (Chapman, et.al., 2009). Studies point out that significantly skewed nurse-patient ratios are likely to lead to patient mortality and the failure to rescue surgical patients (Garrett, 2008). Researchers are also keen to point out that after adjusting for patient and hospital qualities, including size and availability of advanced methods, an additional patient for each nurse was likely to lead to a 7% increase in the failure to rescue and in patient mortality (Garrett, 2008). This ratio is set to increase with each additional patient added to the nurse’s care. These studies establish the fact that a high patient to nurse ratio is the primary cause of decreased quality of nursing care and eventually of job dissatisfaction and changes in careers. A discussion by Clarke, et.al., (2008) set forth how lower staffing levels are related to increased risks of negative, if not poor patient outcomes. Staffing levels, including nurse workload are also associated with occupational health problems like back injuries and needle prick injuries, as well as burnout and stress. Other elements of hospital working conditions also impact on patient outcomes causing the patient to be subjected to poor quality of care or no care at all. Studies point out that due to staffing issues, nurses are likely to leave tasks undone, administer wrong medications to patients, and sometimes, to cause patient falls (Garrett, 2008). Limited availability of nurses also reduces the quality of bed-side care, opening the patients to the greater risk of acquiring pressure ulcers, respiratory infections, and urinary tract infections (Bolton, et.al., 2007). With proper staffing and adequate financing in the health care sector, it may still be possible to avoid these issues in the nursing care practice. Conclusion Budget cuts impact on nurse staffing and on the quality of care in hospitals in the sense that these budget cuts cause the hiring of fewer nurses and for nurses hired to work long, stressful, and overwhelming hours. These overwork status for nurses make them vulnerable to errors in the health delivery, most especially in medication administration. Specifically, it makes these nurses prone to medication errors – missed medications, the administration of wrong kind or wrong dose of medicine, or the administration of the wrong medicine to the wrong patient. These burned out nurses cannot function in the level which ensures adequate and quality patient care. They are likely to fail to carry out all of their nursing responsibilities or carry these out with less quality of care. In effect, budget cuts have negative effects on nursing care and on patient outcomes, endangering the patient’s life and general welfare. Works Cited Baker, J., & Baker, R. (2011). Health care finance: basic tools for nonfinancial managers MA: Jones & Bartlett Learning. Bellebaum, K. (2008). The Relationship Between Nurses' Work Hours, Fatigue, and Occurrence of Medication Administration Errors. Ohio State University. Retrieved 13 July 2011 from http://rave.ohiolink.edu/etdc/view?acc_num=osu1222114579 Bolton, L., Aydin, C., Donaldson, N., Brown, D., Sandhu, M., Fridman, M., & Aronow, H. (2007). Mandated Nurse Staffing Ratios in California: A Comparison of Staffing and Nursing-Sensitive Outcomes Pre- and Postregulation. Policy Politics Nursing Practice, volume 8, number 4, pp. 238-250. Buerhaus, P., Donelan, K., Ulrich, B., Desroches, C., & Dittus, R. (2007). Trends in the Experiences of Hospital-Employed Registered Nurses: Results From Three National Surveys. Nurs Econ., volume 25, number 2: pp. 69-79. Clarke, S. & Donaldson, N. (2008). Chapter 25: Nurse Staffing and Patient Care Quality and Safety. National Institutes of Health. Retrieved 13 July 2011 from http://www.ncbi.nlm.nih.gov/books/NBK2676/ Chapman, S., Spetz, J., Seago, J., Kaiser, J., & Dower, C. (2009). How Have Mandated Nurse Staffing Ratios Affected Hospitals? Perspectives from California Hospital leaders. Journal of Healthcare Management, volume 54, number 5; pp. 321-335. Garrett, C. (2008). The Effect of Nurse Staffing Patterns on Medical Errors and Nurse Burnout. AORN Journal, volume 87, number 6, pp. 1191-1202 Kane, R., Shamliyan, T., Mueller, C., Duval, S., & Wilt, J. (2007). Nurse Staffing and Quality of Patient Care. Agency for Healthcare Research and Quality. Retrieved 13 July 2011 from http://www.ahrq.gov/downloads/pub/evidence/pdf/nursestaff/nursestaff.pdf Mystakidou, K., Parpa, E., & Tsilika, E. (2008). The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients. Sleep, volume 30, number 6: pp. 737-742. 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