JustAnswer



Effects of Inadequate Nurse-to-Patient RatiosIsraa Berro RN, BSNEastern Michigan UniversityMarch 22, 2017A. Health Concern Soaring healthcare costs and diminishing resources have rendered it nearly impossible for healthcare providers to keep pace with the needs of an increasingly sick and aging population. The result, all too often, is reduced quality of care, particularly among those who need care most urgently. America’s most vulnerable populations, the poor, the elderly, minorities, and those who live in rural areas often find themselves without access to adequate medical care, leading to an epidemic of morbidity and mortality from illnesses easily prevented or managed with early intervention. The demand for nurses will remain in issue in all-healthcare systems because of these barriers. The nursing shortage is influencing the inadequate staffing that most hospitals and other medical settings are experiencing. Increased nurse workload and mandatory overtime is causing nurses to be physically and emotionally distressed, missing nursing care while compromising patient safety, as well as leaving the nursing field related to job dissatisfaction. Safe nurse-to-patient ratios should be enacted nationwide to reduce nurse burn out to improve quality of safety and quality of care among patients and the healthcare system.B. Importance of ProblemNurses are the most significant providers at patient bedside. Increased workload can prevent nurses from detecting changes in patient health and also contributes to medication errors. In 2012, the Bureau of Labor and Statistics reported that the expected need for Registered Nurses will increase from 2,737,400 to 3, 449,300, which is an increase of 26% (Cox, Willis, & Coustasse, 2014). Nurses are the major group of employees in the health care field, and they often devote more time with the patient and family members than any other health care professional (Askin & Moore, 2014). One study revealed that in a hospital at capacity, a 10% increase in the quantity of patients assigned to a nurse leads to a 28% increase in adverse incidents, such as infections and medication errors (Askin & Moore, 2014). The rise in adverse events displays negative effects on the healthcare system, mainly healthcare costs. According to Anderson & Townsend (2015), medication errors lengthen hospital stays, increase patient expenses, and lead to more than 7,000 deaths annually in the United States, as each error costs $2000 to $8750. Several factors of inadequate staffing such as nurse burnout, high turnover rates, and older nurses retiring contribute to this health concern. Factors Contributing to Inadequate Nurse Staffing The world population is growing as morbidity and mortality rates are increasing, leading to an increased demand for nurses. The nursing shortage is initiating nurses to experience physical and emotional distress associated with an increased workload. Burnout Syndrome in nurses has been presented to increase about 23% for each additional patient added to the nurse’s shift workload (Holdren, Paul, Coustasse, 2015). According to Holdren et al. (2015), eighty-eight percent of nurses have reported safety concerns with 75% observing a decrease in patient care due to work stress and overworking. Increased workload is leading to high turnover rates, which in turn, is affecting healthcare costs. The Texas Center for Nursing Workforce Studies (2016) stated that high vacancy and turnover is costly to hospitals due to the high cost associated with overtime and recruiting qualified nurses. Older nurses retiring from the nursing field is a significant element causing high turnover rates. Gellasch (2015) specified that baby boomers currently dominate the registered nurse workforce, accounting for 40% of actively working registered who will soon be entering retirement. Nurse burnout, high turnover rates, and the aging nurse population have a major affect on the healthcare delivery system. The Effects of Inadequate Nurse Staffing on the Healthcare SystemRegistered nurses represent the greatest group of health care professionals in the United States and adequate nurse staffing has been related to measures of both patient and nurse satisfaction, and quality of care provided to patients (Everhart et al., 2013). Inadequate staffing leads to nurse burnout causing mediation errors and increased hospitals stays, therefore increasing hospital costs. Registered nurses need to be physically and emotionally supported and prepared to improve patient outcomes. Everhart et al. (2013) stated that hospitals with greater nurse staffing levels resulted in cost savings due to reductions in hospital-acquired infections, shorter length of stays, and improved productivity. Frith et al. (2013) cited a study that found when the proportion of registered nurses increased, the medication errors decreased. Medical errors made by nurses can cause future readmissions, causing hospitals to be penalized and having reduced reimbursements from insurance companies. Askin & Moore (2014) stated that in the year 2010, 31 million Medicare beneficiaries had 10 million hospital admissions causing an increase of medical costs annually by $116,000. Nurses, patients, and hospitals are stakeholders that are affected by inadequate nurse staffing. Analysis of Factors Related to Inadequate Nurse StaffingThe problem of mandatory nurse-patient ratios remains extensively controversial among many vested stakeholders, including nurses, patients, physicians, unions, nursing organizations/lobbyists, researchers, employers, and state governments (Tevington, 2011). The nursing shortage is affecting the healthcare system from all aspects related to nurses, patients, and hospitals. Nurses are not satisfied with staffing ratios as it is affecting their physical and emotional health. They are at high risk of making medication errors and missing nursing care. Dabney & Kalisch (2015) stated that errors of omission in nursing such as failure to reposition patients and missing medications have received little attention in patient safety. Nurses can be involved in addressing this health issue by joining national organizations such as the American Nurses Association (ANA). They can also be involved by writing emails to legislators to speak out their opinion related to health policy bills.Other than nurses, patients are also stakeholders that are affected by inadequate staffing by not receiving proper care and attention, which is causing prolonged hospital stays. Dabney & Kalisch (2015) found that patients conveyed suffering skin breakdown, new infections, and other adverse incidents during their hospitalization. Patients are also struggling with understanding their medical issues because of the lack of communication between nurses and physicians. Patient can become more involved in addressing this concern by participating in their care, accessing their health information online, and joining support groups related to their health condition to feel more prepared in managing their illness. Hospitals are major stakeholders affected by inadequate nurse staffing. The hospital system has to deal with dissatisfied healthcare workers because of poor staffing and spending more money recruiting for other nurses, while others are leaving. They also have to contract with insurance companies correlated with hospital costs and reimbursements. The rise in hospital costs is related to increased falls, infections, pressure ulcers, and other issues affected by inadequate staffing. Hospitals can become more involved with this issue by supporting nurses and improving nurse-to-patient ratios. This in turn will help decrease hospitals costs and readmission. If safe nurse staffing ratios are enacted in all hospital organizations, nurses will be more satisfied with their jobs as hospitals do not need to spend more money training new nurses and losing experienced ones. The major health system factor affecting poor nurse staffing ratios is the financial costs of hospitals. Health System Factors Affected Addressing Inadequate Nurse StaffingMedicare and Medicaid are penalizing hospitals in regards to hospital readmissions. Hospitals are spending lots of money on medical conditions such as infections, caused by missed nursing care from poor staffing. Hospitals are affected by changes to Medicare payment structure, decreased payments associated with hospital-acquired infections and readmissions, and the loss of Disproportionate Share Hospital payments (Askin & Moore, 2014). Improving the staffing ratios in all hospitals can help reduce readmissions and increase hospital reimbursements. McHugh et al. (2015) found that a much larger proportion of nurses working in better-staffed hospitals reported being confident that their patients were prepared to manage their own care upon discharge. Nurses feel better prepared in providing care and education when they are not under lots of stress. Professional factors such, as nurse accountability and responsibility are relevant to this health concern. Cultural factors including patient safety and values is also pertinent to inadequate staffing.Relevant Cultural/Professional FactorsPatient value and safety are compromised in relation to inadequate staffing. Patients trust that healthcare professionals are competent enough to provide them physical and emotional support. They rely and depend on nurses and physicians to assist them with their medical and environmental needs. Key elements of a culture of safety in an organization include the establishment of safety as an organizational priority, teamwork, patient involvement, openness/transparency, and accountability?(Barnsteiner, 2011). These needs can be addressed by spending quality time with patients, while providing education and advocacy. Professional factors include the increase in nurse accountability and responsibility. Inadequate staffing causes nurses to have a greater chance of making a medication error, which puts their license and job at risk. The nursing shortage is driving nurses to work in unsafe settings. Goeschel (2011) found that accountability improves when providers are involved in creating safer systems.Plan to Address Inadequate Nurse StaffingSince nurses are the largest population in the healthcare setting, they should be the main ones speaking out to improve patient safety, patient outcomes, and quality of care. Outcomes measure such as joining multiple nursing organizations and writing letters to legislators to improve satisfaction and reduce nurse workload; supporting professional nursing practice and mandating safe nursing workplaces. Adequate staffing can decrease medication errors, increase patient safety, and reduce hospital costs. Finances to Implement Adequate Staffing The World Health Organization (2010) stated that annual financial losses due to healthcare-associated infections were significant, leading to direct costs at about $6.5 billion in the United States. Nurses and other healthcare providers can help reduce these costs by frequent hand washing between direct patient care and following infection precaution protocols. Healthcare-associated infections are also a result of missed nursing care linked to inadequate staffing. Adverse drug events are correlated with an increased length of stay in the hospital (1.7 days), increased hospital costs (an additional $2000), and an increased risk of death (1.9 times high than those not experiencing an adverse drug event (Weiss & Elixhauser, 2013). Nurses can implement specific interventions to support safe nurse-to-patient ratios. Interventions for Adequate Staffing Recruiting middle school and high school students from diverse populations to pursue a career in nursing is a strategy to help improve the nursing shortage. Educational fairs that discuss the world of nursing could be an option. Also, nurses can join organizations to help fund for scholarships to help students pursue an education in nursing. According to Lerner & Cohen (2003), it is now time to increase recruitment of future nurses by creating an interest in the profession among young students. Assisting in promoting safe nursing practice and being more involved in decision-making related to healthcare policies can be accomplished by writing to legislators or meeting with them. Ethical & Legal Issues of Inadequate StaffingIn most states today, there are no active laws or bills set mandating safe nurse-to-patient ratios. However, that state of California became the first state to establish minimum registered nurse (RN)–to-patient ratios for hospitals with the passage of bill number AB 394 in 1999, according to Kasprak (2004). Aiken et al. (2010) stated that California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units.?The obligation of mandatory nurse-to-patient staffing ratios should be nationwide, not specifically enforced to one state only. The challenge of responsibility for nurses is correlated with medical errors, leading patients and families to file lawsuits against the hospital and the nurses. This is linked to the perception of work satisfaction and mandatory overtime, promoting physical and emotion distress in nurses. Evaluating the interventions to implement safe nurse-to-patient staffing is continuing process.Evaluation of Adequate StaffingHospitals are the main systems to evaluate if the barriers to staffing are being addressed. Evidence-based research and statistical data are changing constantly based on experimental and clinical data. However, hospitals will implement in-service training based on the most updated clinical practices to decrease falls, infections, pressure ulcers, and central-line associated blood stream infections, which in turn will decrease mortality rates and hospital costs. The Joint Commission’s visits to hospitals, nurse satisfaction surveys, and HCAHP scores are other methods to evaluate safe staffing. According to Hashem et al., (2014), higher satisfaction with care has been associated with lower patient mortality, better adherence to practice guidelines, and reduced readmissions. Nurses have to be involved to speak out and take action to help improve staffing levels to improve the quality and safety of care among patients. ReferencesAiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., . . . Smith, H. L. (2010). Implications of the California Nurse Staffing mandate for other states.?Health Services Research,?45(4), 904. doi:10.1111/j.1475-6773.2010.01114.xAnderson, P. (2015). Preventing High-alert Medication Errors in Hospital Patients.?American Nurse Today,10(5), 18-23.Askin, E., & Moore, N. (2014).?The Health Care Handbook: A Clear and Concise Guide to the United States Health Care System. St. Louis: Washington University in St. Louis.Attorney, J. K. (n.d.). California RN Staffing Ratio Law. Retrieved March 24, 2017, from , J. (2011). Teaching the culture of safety.?Online Journal of Issues in Nursing,?16(3), 1J.Cox, P., Willis K., & Coustasse A. (2014, March). The American epidemic: The U.S. nursing shortage and turnover problem. Paper presented at BHAA 2014, Chicago, IL. Dabney, B. W., & Kalisch, B. J. (2015). Nurse staffing levels and patient-reported missed nursing care.?Journal of Nursing Care Quality,?30(4), 306-312. doi:10.1097/NCQ.0000000000000123Everhart, D., Neff, D., Al-Amin, M., Nogle, J., & Weech-Maldonado, R. (2013). The Effects of Nurse Staffing on Hospital Financial Performance: Competitive Versus Less Competitive Markets .?Health Care Management Review,38(2), 146-155. doi:10.1097/hmr.0b013e318257292bFrith, K. H., Tseng, F., Fong, E. A., & Anderson, E. F. (2012). Nurse staffing is an important strategy to prevent medication errors in community hospitals.?Nursing Economics,?30(5), 288.Gellasch, P. (2015). The Driving Forces Behind Nurses Leaving the Profession.?Nurse Leader,13(5), 63-68. doi:10.1016/j.mnl.2015.01.001Goeschel, C. (2011). Defining and Assigning Accountability for Quality Care and Patient Safety.?Journal of Nursing Regulation,2(1), 28-35. doi:10.1016/s2155-8256(15)30299-4Hashem, F., Canar, J., Fullam, F., Gallan, A., Hohmann, S., & Johnson, C. (2014). The Relationships Between HCAHPS Communication and Discharge Satisfaction Items and Hospital Readmissions.?Patient Experience Journal,1(2), 12th ser., 71-77.Holdren, P., Paul III, D. P., Coustasse, A. (2015, March). Burnout syndrome in hospital nurses. Paper presented at BHAA International 2015 in Chicago, IL Lerner, H., & Cohen, B. J. (2003). Recruiting students into nursing.?Nurse Educator,?28(1), 8-9. doi:10.1097/00006223-200301000-00005McHugh, M. D., Berez, J., & Small, D. S. (2013). Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing.?Health Affairs (Project Hope),?32(10), 1740.Tevington, P. (2011). Mandatory nurse-patient ratios. Medsurg Nursing: Official Journal of the Academy of Medical-Surgical Nurses, 20(5), 265.Weiss AJ (Truven Health Analytics), Elixhauser A (AHRQ). Characteristics of Adverse Drug Events Originating During the Hospital Stay, 2011. HCUP Statistical Brief #164. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download