Nursing shortage and its effects on the provision of health care - Term Paper Example

Nursing Shortage and its Effects on the Provision of Health Care Nursing Shortage and its Effects on the Provision ofHealth Care Introduction Most hospitals are undergoing numerous challenges. Governments have continually been passing legislations meant to arrest the rising prices of hospitals. Over the last few years, technological advancements including less complicated surgical procedures have lessened the requirement for inpatient care on one side and increasing the inpatient capacity in nearly all the hospitals. On the other hand, the intricacy of medical and clinical interventions carried out in most hospitals demands the availability of a bloated hospital workforce. Reconciling budget limitations and increased bed capacity with rising intricate, labor-intensive clinical care needs has been a challenge for most hospital leaders. The lessening of hospital intensive capacity has been a common feature for more than ten years now. In addition to this, there have been numerous managerial reforms that have been undertaken to enhance efficiency in the hospital sector. These strategies have taken diverse forms with some dwelling on novel organizational planning such as straight down and parallel integration of services, amalgamations while others have been focusing on reengineering and work design (Aiken, Clark, & Sloane, 2002). Despite these wide reaching transformations, there is credible evidence that the changes have not been well received. In a recent survey where consumers were asked to report on their most current hospital stay as well as quality, availability, and cost-effectiveness of health care in several European countries, substantial displeasure with the provision of health care was recorded. Conspicuously, 20% of US and UK consumers and 30% of Canadian consumers categorized their last hospital visit as fair or poor. Physicians agree that the quality of healthcare in the countries where this study was commissioned is threatened by shortage of nurses. Studies carried out in the hospitals where there have been restructuring shows that there have been high levels of nurse dissatisfaction (Unruh, 2008). In the light of this study, it is clear that restructuring in hospitals has a great effect on the quality of healthcare and it also has a great effect on the manner in which nurses carry on their work. Background of the Staffing Problem The healthcare system in the U.S. and other European countries has been in a crisis for the past few years. Despite renewed efforts at reform in most European countries, the number of uninsured people continues to grow, the cost of healthcare continues to soar, and the safety and quality of care are queried. The great challenges of the healthcare system need significant attention on the part of health experts, policy makers and the society. One problem that has continued to dog the health care sector over the last five years has been the perennial shortage of registered nurses as well as other health care professionals as a demonstration of the fragility and faults in the health care system. For health care delivery to be efficient, reasonable, and inexpensive, there must be an ample stream of knowledgeable, well spread and employed certified nurses (Buerhaus, 2010). While the general quality of care seems to have responded progressively to the rising emphasis on evidence-based practice and performing procedures, major inequalities in quality stubbornly persist. The health care system and the nursing profession are once more witnessing a shortage in nurses that is augmented by shortcomings of the system and the ever-rising need for health care, as the baby boomers grow old. The intricate environment of challenges of the health care system requires major attention on the part of health care professionals, policy makers and to a smaller extent the public (Buerhaus, 2010). In all the healthcare literature available today, the widely accepted elements of healthcare reform are the ability to get health care, its quality, cost, and the workforce in the health care sector. Since health care is considered a primary human right, its provision should be restructured to make sure that its access is available to every Canadian. The current disjointed system of employer-based coverage and government-funded programs that are directed towards certain populations does not guarantee access to health care services for all citizens. Access must not only be affordable and accessible but it should also be acceptable to everyone. Better access can be guaranteed by expanding the services offered by all categories of health providers and by widening the range of services that must be integrated to offer reasonable patient choices (Buerhaus, 2010). On its part, affordable health care is offered in an environment that offers treatment and follow-up care that are fairly priced with patient co-payment that are founded on an individuals capability to pay. In addition to this, health care provision must be available in convenient hours, places, and waiting times to cater for working class families, incapacitated people, and people across the life span. Although health care might be accessible and available, this is not enough if it is not quality. Therefore, a transformed health care scheme must offer consistent and quality care across the continuum of the consumers who access it. Although the various stakeholders in the Canadian health care system have been trying to ensure that this is guaranteed, the existing nurse-staffing crisis in all government hospitals has continued to challenge this prospect. Naturally, for health care to be appropriate there is need for health care professionals who are adequately trained to meet the consumer needs (Aiken, Clark, & Sloane, 2002). For a long time now, medical researchers have been working hard to establish the connection between nursing staffing and the quality of care that patients receive in hospitals. However, the problem with these studies is that these two studies were examined just as variables and not as serious areas warranting study. In the last one decade, the need to cut costs has led to major cuts in the number of nursing staff in major hospitals and this has greatly affected healthcare provision in these hospitals. Due to the rising cost of living, human resources and nurse staffing have undergone significant reduction in an effort to cut costs. These cuts in nursing workforce brought about concerns about the availability of nursing staff in health care centers. Because of this scenario, a societal and professional concern on the quality and the safety of patients has been awakened by the recent media attention on this matter (Aiken, Clark, & Sloane, 2002). Beginning 2010, there were emerging reports in the media about the unrivalled shortage of nurses that came about because of the baby boomers who had made the demand for nurses to go up sharply. About the same time, there was a sharp drop in the number of nursing graduations that had been occasioned by the inability to hire nursing staff hence making this profession less attractive. This new occurrence is estimated by analysts to have contributed to the decline in working conditions in many hospitals (Buerhaus, 2010). The associated healthcare finance, the market forces, as well as the emerging professional and societal policy forces renewed the focus on the study about the effect of nurse staffing and their effect on the quality and patient safety. The intensity of these studies has increased the need to understand the staffing results as well as offering nurses with the right tools to understand the importance of offering care under favorable staffing circumstances (Buerhaus, 2010). The main thing, which emerges from the examination of these circumstances and which might determine the success or failure of the staffing levels problem is the fact that administrators are central to solving the problem. This is because such individuals are in charge of the controlling forces that include budgetary allocations as well as other areas of the local nurse labor markets. Having effective administrative practices determines the prevailing structure of the nursing staff that is allowed to work in various subunits in a hospital. Put together, these factors also determine the combination and uniqueness of the nurse labor force as well as the model of care that is adopted when assigning staff to work in the various units. These factors are also critical when it comes to defining the various workplace environments that are prevalent in a hospital (Buerhaus, 2010). In the past, the quality of health care offered in most of the Canadian hospitals was influenced by various personal nurse traits and especially expertise and familiarity. The quality of care is also greatly influence by the setting in which nurses operate in, with this being inclusive of the staffing levels as well as the needs of the patients to which a nurse has been allocated to. The accessibility and the organization of other staff services as well as the environment and prevailing culture in the hospital affects the quality of health care provision (Buerhaus, 2010). Implications of Low Level of Nurse Staffing As observed earlier, the most current nursing shortage and concerns about unavailability of nurses were brought about by the cost-cutting practices introduced by the government in the 1990s at the height of managed care. This program targeted mostly the positions that were occupied by registered nurses as well as the middle management, which were believed to be the biggest component of the hospital staff. While the costs of nurses turnover have been around for over three decades, it is only upon the inception of current literature that linked poor nursing care with poor patient results that gave room for the calculation of the real costs associated with poor staffing (Unruh, 2008). Over the years, very little research has been directed towards looking at the link between hospital nurse staffing and cost effects. Despite this lack of supporting literature, one thing that comes out clearly is that nurse staffing has a direct association to the duration of hospital stay and therefore potential cost savings. Ideally, more than 90% of the cost saving measures that come as a result of increasing nurse levels can be achieved by decreasing a patient’s length of stay in the hospital. From this analysis, it therefore follows that lessening the duration that a patient spends in hospital pushes the patient turnover up consequently increasing the nursing workload. The main reason why patients are hospitalized is because they require specialized nursing care. This in itself leads to the conclusion that nurse staffing is linked to numerous other outcomes. There is also enough evidence to prove that having sufficient nurses can significantly shorten the duration that a patient stays in hospital can significantly bring down the duration that a patient stays in the hospital as well as have an effect on events and costs. Armed with this knowledge, people who manage hospitals and especially those with low levels of nurses have to ask how costs would go up if they added their current level of nurse staffing. Although the probability that an increase in nurse staffing is directly linked to enhanced health care provision, most hospitals do not take this prerogative since they are not able to afford these costs. However, there is also another side to this debate since increasing nurse staffing is seen as a sure way of increasing the chances of attracting more lucrative patients (Unruh, 2008). Researchers have repeatedly established that lower staffing levels are directly linked with inflated costs and the risk of poor patient outcomes. Staffing levels and especially those that are associated to the amount of workload especially among the nurses also has a big effect on work related health care issues. Some of these issues include back injury as well as needle injuries that a nurse has also seem to have a big connection to nurse workload as well a big host of psychological states that the nurse might experience in his workplace (Unruh, 2008). The biggest problem that has made it hard to find the link between staffing issues and the related issues is because the link might not be obvious every time that they happen. There are also other areas of hospital working conditions that are outside the area of staffing coupled with individual nurse and patient traits that might affect the prevailing outcomes since downbeat outcomes are comparatively even at the acute cases of staffing and do not happen in each case where staffing is low. Despite this lack of negative outcomes, it is apparent that nurse staffing is connected to numerous aspects of the health care system and should therefore be treated with more seriousness unlike in the current case (Unruh, 2008). Nurse to Patient Ratios While the Canadian policy makers have constantly ignored the issue of nurse staffing for long, the truth is that it has a great impact on the manner in which nurses carry on their professional work. Today, nurses in Canadian healthcare facilities are struggling to offer secure patient care and excellent nursing services to the people in proficient practice environments where there are no principles that classify minimum staffing levels. This problem continues to persist despite the broad research that point out the effect of insufficient staffing levels on patient effects, quality of care and patient safety as well as the nurses wellbeing. The nursing shortage in Canada has amplified the conditions where nurses are operating with insufficient staffing. Regardless of the lack of formal staffing plans as well as staff mix frameworks formulated by the association between researchers and regulatory bodies to aid nurse managers to form formal staffing plans, the bulk of research still shows that decisions in numerous health care provision facilities in Canada are still made on an ad-hoc basis. While there are numerous guidelines formulated to safeguard the interests of the public in other sectors, there are no nursing guidelines that are meant to direct the profession (Buchan, 2005). In most cases, the professional standards only cushion the public in the event that the individual nurses’ proficiency or ethics is at stake, and cannot be depended to guarantee that a minimum standard of patient care in situations where all nurses are proficient, but simply overworked. In the absence of legislations or enforceable professional principles, the big question that remains to be answered is where can nurse and the public run to make certain that the public get a least standard of care, and that patient and public safety is guaranteed. In other parts of the world, the answer to this pressing question has been the introduction of formal nurse-patient ratios. If implemented in Canada, such ratios can become the answer to this burning issue (Buchan, 2005). Ideally, the issue of mandatory nurse-patient ratios is still one of the highly contentious issues in the nursing profession. The support for compulsory nurse-patient ratios comes from the belief that regulate registered nurse (RN) staffing will lead to positive patient outcomes, bring down the current nurses shortages and raise nurse recruitment and job satisfaction. Better RN staffing results is also expected to enhance the quality of patient care (Gordon, Buchanan, & Bretherton, 2008). Although there is no any kind of legislation that addresses the issue of nurse-patient ratios, California can learn from other outside jurisdictions. The reason for this is because the problems that face the Canadian health care system are analogous to those in the American health care system. Research has continually showed that adequate staffing and balanced workloads of nurses are crucial to the attainment of good patient, nurse and financial results and hence the reason why many states in the U.S. are trying to set up a mandatory nurse-patient ratio. However, the only challenge with the passage of such laws is that it has great effects on the nurses, patients and indeed all the stakeholders and as such, the passage of such a law demands that there be enough evidence on its effects. The biggest challenge with passing laws is that once they are adopted, it becomes so hard to recall the law in the event that it is found not to be effective. Another major concern that can make the passage of a legislation to address the nurse-patient ratios is that it leads to the ignorance of significant factors such as the standard of education, kills, knowledge, as well as the experience period. In the places where such a bill has been introduce, only 50% are supposed to be registered nurses and this therefore places a very thin line between licensed professional nurses and registered nurses. Mandatory staffing ratios also fail to factor in other significant factors such as the length of stay in hospitals, the dynamic state of the nurse teams doctor preferences, environmental challenges, disparities in technology, as well as the availability of supporting staff. Ideally, the passage of such a bill is considered inflexible and fails to factor in the vibrant transformations in patient needs that nurses recognize and for which they should make their contribution (Gordon, Buchanan, & Bretherton, 2008). Despite the overwhelming evidence that the adoption of patient-nurse ratios might have a great impact on healthcare provision, this might not always be the case. If such a legislation is adopted in Canada, the desire to cut on cost would lead to the dismissal of the auxiliary staff something that would mean that patients would be held more in emergency rooms. Due to the increase of the nursing staff, employers would have increased economic costs due to the bonuses that they would have to pay the new nurses. Due to the dismissal of the ancillary staff, the nurses would have to perform the extra chores and this would still increase their workload just like before (Douglas, 2010). Since the greatest desire of every employer is to make profits, an increase in the number of nurses would see them cut down on the cost of other essentials such as equipment as well as introduce environmental changes. In all likelihood, most employers would choose to rather pay the imposed fines if they do not comply than to meet the huge expenses that are accompanied by trying to adhere to these guidelines. In the event that changes are effected without consulting the nurses, the employers might succeed in restoring some sort of quality in the provision of healthcare but the increased workload among the nurses would still pose extra challenges since it would take away their independence. Instead of just factoring in governmental interventions, there is need to integrate the dynamic input of technology, capital, and economic and labor supply variables since they have a great effect on the hospitals and the nurses themselves. Lastly, allowing the government intervention would mean that nurses would not get the chance to vouch for evidence-based practices that are critical for the best doctor outcomes (LeMoal, 2013). Despite the challenges that are accompanied by the continued lobbying for hospitals to implement the nurse-patient rations, passing such legislation is bound to bring about numerous benefits on the Canadian health care system. To begin with, nurses will undoubtedly be forced to increase knowledge on what is ideal for their profession as well as their patients as well as to look for more ways to bring changes into this sector. However, for this to be effective, it is critical that the nurses be involved in the lobbying process since they are the only ones who can give evidence based interventions that is significant for bring changes into the nursing field. Instead of trying to implement the changes blindly, there is need to consider various critical factors and this will call for an active participation of nurses in all the decision making process (Gordon, Buchanan, & Bretherton, 2008). Conclusion There is sufficient research to prove that allocating lesser patients per nurse or providing increased nursing hours per patient is directly linked to reduced adverse outcomes. Unlike in the past, this link is firmly established using current literature. However, there is still no sufficient research to enable a clear understanding of the specific effects of variables that may be combined with the staffing issue to affect health outcomes and especially at the hospital level. One area that need to be examined is how staffing is linked to the provision of care in the health care system. The biggest challenge in achieving this objective is that hospitals are still faced with the challenge of cutting on cost while offering effective health care at the same time. This is something that will need to be addressed in the future since there is very little research on this area at the present. References Aiken, L., Clark, S., & Sloane, D. (2002). Hospital staffing, organization, and quality of care: Cross-national findings. Nursing Outlook, 50(5), 187-194. Buchan, J. (2005). A certain ratio? The policy implications of minimum staffing ratios in nursing. Journal of Health Services Research, 10(4), 234-244. Buerhaus, P.I. (2010). It’s time to stop the regulation of hospital nurse staffing dead in its tracks. Nursing Economics, 28 (2), 110-113. Douglas, K. (2010). Ratios — If it were only that easy. Nursing Economics, 28(2), 119-125. Gordon, S., Buchanan, J., & Bretherton, T. (2008). Safety in Numbers: Nurse-to-Patient Ratios and the Future of Health Care. Cornell University Press. LeMoal, L. (2013). Nurse-patient Ratios in the Canadian Context. Retrieved from http://www.thinknursing.ca/sites/thinknursing.ca/files/Nurse_Patient_Ratios.pdf Unruh, L. (2008). Nurse staffing and patient, nurse and financial outcomes. The American Journal of Nursing, 108(1), 62-71. Read More