Nursing - The Management in Staffing - Essay Example

? Outline Introduction 2. Key points 3. Empirical evidence 4. Importance and implication 5. Conclusion 6. Summary Introduction Policy development on nursing needs to pay attention to staffing. Studies have proven that hospital mortality could be attributed to staffing issues. The effectiveness or failure of the management in staffing could determine the rate of mortality within the hospital. The policy formulators therefore, must consider staffing in their attempts to set policies aimed at smooth operation of hospital. The elements of staffing that need consideration include staffing ratios and mix hours, staff rotation and duration of the rotation and overtime and weekend staffing. Although the government has attempted to develop robot nurses, the scientists are yet to succeed in that front. Up to date all nurses are still human thus the need to adopt staffing policies in consideration that the players are human in nature (Roussel, 2011). Staff ratio Staffing ratio entails the number of registered nurse per patient. The ratio could compare the registered nurse per surgical or hospitalized patient. Further, the ratio could be a registered nurse per shift or per patient day. It is imperative for the proportion to be as low down as feasible so that a lesser number of patients is assigned to registered nurses. Nurses being human, also suffer fatigue and exhaustion. When exhausted, a nurse’s effectiveness deteriorates and could lead to the death or atrophication of the patient’s health (Finkelman & Kenner, 2012). Shift rotation and duration Nursing can be structured in shifts whereby the nurses have specific times when they would be on duty. The length and time of the shift is critical in the effectiveness of the nurse. Ideally, the nurse should be on duty for the duration in which s/he is able to concentrate fully. Patients whether surgical or hospitalized would need attention and the nurse should be at her/his best to give attention. When a shift takes too long, the nurse would suffer from fatigue and lose concentration (Griffin, 2011). This gives leeway for the occurrence of procedural or medical errors. The duration must therefore, be long enough to cover for the economic ability of the hospital management but also short enough to guarantee the concentration of nurses. The shifts must also be rotated among the nurses. It is prudent to spread the shifts to all the nurses so that everyone enjoys the burdens in a particular shift. This especially relates to the night shifts which is usually less convenient for most nurses. It is important to provide incentives that would encourage participation by nurses in the night shifts. The management must however consider other factors such as the age of the nurses, marital status and family commitments in electing the night shift nurses (Griffin, 2011). Overtime and weekend staffing Nurses may be forced to work overtime due to strained resources. However, this is risky and should be a measure of last resort. An overtime worker has never been productive in any industry. The nursing profession is more delicate as it deals with the life of patients. It is proper to avoid working nurses overtime as this compromises their effectiveness hence poor delivery which translates to higher risk of hospital mortality. The management should adopt the more difficult option of hiring more nurses rather than opting for overtime (Fernandez, 2010). Weekend staffing is inevitable considered that patients do not cure during weekends. Policy formulators need to appreciate that packages must be friendlier to attract nurses to work over the weekends. The effectiveness of a nurse working over the weekend is however not compromised by the fact that the days are weekends (Fernandez, 2010). Empirical evidence Research has attempted to estimate the ratio of hospital mortality to nursing hours. In this analysis, hospital mortality refers to death in the hospital or within thirty days after admission in the hospital. Research has proven that an increase in the registered nurses which meant a higher ratio of registered nurses to patient ratio, within the intensive care unit and the surgical units lead to a reduction in deaths. The death rates were lesser despite the fact that the only factor that had changed was the number of the registered nurses assigned to those units. Researchers noted similar trends when the one additional registered nurse was available per one thousand patients. In addition, when one additional patient was increased per one registered nurse, the hospital related mortality increased by 0.1 percent. This attested to the researchers’ findings. This was a slight increase but substantial enough to be applied as evidence in support of a policy to increase the ratio of nurses to patients (Kane, Shamilyan, Mueller, & Wilt, 2011). Further, research showed that an increase by one registered nurse per patient day caused a 1.2 percent reduction in hospital related mortality rates. Research by various studies showed that increasing the registered nurse to patient per day ratio contributed to a diminution in the relative risk of hospice related mortality. The adjusted risks level according to seven studies was reduced by seven percent by adding one registered nurse to the ratio of registered nurse to patient per day (Fernandez, 2010). In surgical patients, the ratio was even more relevant as the ratio of registered nurses to patients was more significant. In the analysis, relative risk of hospital mortality was 0.76 times lesser when less than two patients got their help from one registered nurse compared to assigning four to six patients to one registered nurse. The results from the intensive care unit were even more convincing. In ICU, there was a six percent reduction to hospital mortality when one registered nurse attended to less than three patients rather than assigning one registered nurse to three to four patients. Therefore, if the relationship between staffing and hospital mortality is causal; then, by making estimates increasing the number of registered nurse by one would save one thousand hospitalized patients while reducing the workload from six to four patients per registered nurse per shift to about four or less would save twenty three lives per one thousand hospitalized patients (Roussel, 2011).What the studies noted which is of relevance to mention is that surgical patients suffered more from low numbers of registered nurses compared to the hospitalized patients. This can be attributed to the nature of special attention that surgical patients require compared to the attention hospitalized patients would need. Studies indicate that thirty-eight percent of deaths of surgical patients could be traced to nurse conscription in centers with more than six patients per registered nurse (Roussel, 2011). The studies did bring out the effect of the qualification of nurse. There was a correlation between the hospital mortality rates with the qualification of the nurse. In hospitals where the nurses were holders of the BSN degree, the hospitality mortality rates were between nineteen and thirty seven percent lesser compared to the hospital with nurses who were non BSN degree holders (Griffin, 2011). In the collection of more evidence, studies have attempted to examine the involvement between nurse to patient ratio and nurse sensitive outcomes. Considering rescue for instance, it was observed that an increase by one patient per registered nurse per shift corresponded with a noteworthy augment in failure to liberate by 0.35 percent (Griffin, 2011). Importance of the policy issue The issue of nurses staffing is extremely fundamental to nurses and their patients. From a reasonable person’s perspective, increasing the number of registered nurses in a ward or hospital will lead to better patient outcomes. A high number of registered nurses mean fewer deaths in a hospital and fewer heart attacks. If say a nurse tends to six patients a day compared to twenty patients a day; the nurse is able to get a grasp of issues affecting the patients and will attend to them promptly and desirably (Fernandez, 2010). A study by the Janice Ellis from the Washington State Nurses Association discovered that nurses who worked in under staffed hospitals worked more overtime hours. These nurses had high cases of patient deaths occurring under their care. In addition, the patients they attended to developed nosocomial infections and blood stream infections. The reason was that nurses who worked overtime rarely slept. As a result, they became easily fatigued and their cognitive abilities became numbed. This affected the quality of their services. There were cases of patients getting improper medication and some nurses forgetting to inject patients when the nurses were making rounds in the hospital. In adverse cases, nurses sent flawed reports to doctors hence causing the doctors to offer inappropriate medication (Fernandez, 2010). The effects of overtime work and under staffing extend beyond the patients’ safety. These issues also affect the nurses’ personal health and safety too. For instance, a nurse who works during the day and then works overtime at night is very likely to leave the workplace feeling drowsy. If the nurse drives an automobile, he/she has a high chance of causing an accident. Overtime work and the effects of handling many patients during the day causes stress for nurses and constant exhaustion. These opportunistic conditions extend to their family lives (Finkelman & Kenner, 2012). Some nurses end up getting divorced and others release their stresses in an inappropriate manner such as alcohol and extreme anger. In essence, nurses who have worked long repetitive shifts get fatigued and may cause injury to themselves in the course of their work. Nurses handle needles as they work and may prick themselves. They may also spill toxic chemicals on themselves. Some nurses who get fatigued from their work may let their guard down and contract communicable diseases from the patients (Finkelman & Kenner, 2012). Impact of the policy issue The need for the policy on staffing needs not be stressed further from the effects I have discussed above. The policy will reduce the number of deaths and aggravated conditions of patients if implemented. The priority of the staffing policy is to ensure that patients get quality health care. If a nurse attends to a manageable number of patients within acceptable working hour limits, the outcome will be superior to the outcome of a nurse who handles a high number of patients while on a day long shift. The policy will also increase the satisfaction nurses get from their work and will improve the quality of their life. Nurses who are healthy and jovial do a better job than nurses who consider their job stressful and dead end. The policy also sorts the issue of few registered nurses by giving the nursing profession an attractive image. If outcomes of nurses are excellent, the public will gain respect for the profession. Investors will get motivated to increase their funding and many people will consider taking up the nursing career (Kane, Shamilyan, Mueller, & Wilt, 2011). Conclusion I strongly advocate for the staffing policy. While it may not solve all the issues in the health care sector, it guarantees that future reforms in the health care system will lie on a reliable foundation, which consists of nurses and other healthcare service members. The best way to approach problems in our health sector would be to motivate the nurses and doctors. The staffing policy is a cheap solution since it does not involve offering incentives to the nurses. It focuses on making their workplace better than the current condition. In my view, the staffing policy would be the best bet policy makers can make in improving the health sector (Griffin, 2011). Summary The policy of issue in this discussion is the staffing policy. I have underlined the staffing ratio is a major point of concern in the policy on staffing. The argument in focus in this paper is that the ratio of nurses to patients should be reduced. The other areas of concern are the shift duration and rotation. My proposal recommends reducing the shift duration because nurses who work long hours are not productive. On shift rotation, nurses should be rotated frequently to improve the quality of care extended to patients. The final key issue was on overtime and weekend staffing. Overtime hours should be reduced and weekend staff should be different from weekday staff. The weekday staff will not be fatigued if this proposed arrangement gets incorporated into the policy. The paper demonstrates that understaffed hospitals are not conducive to nurses and patients in the hospital because of high levels of stress. Secondly, overtime hours should be reduced because they make the nurses fatigued and they make errors as a result. References Fernandez, B. (2010). Health Care Reform: An Introduction. Collingdale, Pennsylvania: DIANE Publishing. Finkelman, A., & Kenner, C. (2012). Professional Nursing Concepts: Competencies for Quality Leadership. New York: Jones and Bartlett Publishers. Griffin, D. (2011). Hospitals: What They Are and How They Work. New York: Jones and Bartlett Publishing. Kane, R. L., Shamilyan, T., Mueller, C., & Wilt, T. J. (2011). Nurse Staffing and Quality of Patient Care. Agency for Healthcare Research and Quality . retrieved from: http://www.ahrq.gov/downloads/pub/evidence/pdf/nursestaff/nursestaff.pdf Roussel, L. (2011). Management and Leadership for Nurse Administrators. New York: Jones and Bartlett Publishers. Read More