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Safe StaffingKris KonoLCSC- BSNSafe StaffingImagine for a second, you present to the emergency department with severe abdominal pain, and wait to be seen for more than an hour. By the time you are assessed, your pain is so bad you can hardly stand, and you are now vomiting and your belly is bloated, large and hard. It takes another two hours for medical staff to discover you have a complete bowel obstruction, and need emergency surgery. Discovering a bowel obstruction is fairly easily done by performing an x- ray or CT scan, however, without adequate staffing, treatment can be delayed and potential for damage to tissues or organs can increase. Now imagine you arrive to the general surgical floor, and your nurse, as fantastic as she/ he are, also has six other patients to care for. How confident would you be in your nurses that they will provide the best care for you without feeling the stress of six other patients? A study of 232,342 surgical patients in Pennsylvania revealed that 4,535 (2%) died within 30 days of discharge. The significance of this study suggests that the differences in nurse- to- patient staffing ratio (4:1 vs. 8:1) may have been a factor in those patients’ deaths, (Shekelle, P., 2013). When we describe “caring” for the patient, we are referring to a huge umbrella of skills and knowledge in which many mistakes can be made, and unfortunately are made daily. Researchers have discovered that the survival rate of patients improves with higher number of nurses because nurses spend more time with the critically ill patients than any other healthcare professional do, and are more likely to detect early signs of deterioration. Another reason is that fewer permanent staff might mean greater reliance on agency staff that may have less expertise or be unfamiliar with some aspects of a unit’s way of working, (Duffin, C., 2014).In a bill introduced into congress in 2013 would require hospitals to establish committees that would create unit- by- unit nursing staff plans based on multiple factors, such as number of patients on the unit, severity of the patients conditions, experience and skill level of the RN’s, availability of support staff, and technological resources, (ANA, 2013). Staffing plans are developed annually and are based on past data, patient volume, acuity, regulatory standards, external and internal benchmarks, nursing skill mix and experience, and budget, (Association of PeriOperative Nurses, (2013). In addition to patient safety, low nurse- to- patient ratios are increasing nurse burnout and job dissatisfaction. The shortage of hospital nurses may be linked to unrealistic nurse workloads. Forty percent of hospital nurses have burnout levels that exceed the norm for healthcare workers. Hospital nurses are four times greater than the average US worker to report job dissatisfaction, and 1 in 5 hospital nurses claim they intend to leave their current jobs within a year, (JAMA Network, 2002). Thus the question remains why aren’t hospitals adequately staffed? There are several factors to consider. One, the day of the week- is it a weekday or weekend? Second, what is the facilities budget? Third, who is compiling the staff schedule? Let’s discuss what day of the week you presented to the emergency department with severe abdominal pain. If you came to the hospital on a Tuesday, more than likely there was enough medical staff to assess, diagnose and treat you in a timely manner. However, if you presented to the emergency department on a Saturday, unfortunately the opening scenario may not be far off. This is because on the weekends, doctors are not necessarily in the facility, but rather on- call. There may not be a sufficient number of nurses to efficiently care for an influx of admitted patients. In addition, there may not be an adequate number of Certified Nursing Assistants to help with vital signs, and other skills within their scope of practice, creating more work for the nurses. Also, depending on your specific needs, there may not be a radiology technician on site, or adequate staff in the surgical unit. Secondly, facility budget is something to factor into the number of nurses employed. Although I don’t know anything about hospital budgeting, I know that all businesses have budgets, and goals to reach. When goals aren’t reached, budgets get reduced, staffing suffers, and it’s the consumer who pays the price. In this case it will be the patients and their families.Thirdly, who is actually making the staffing schedule? Do they have a clear understanding of where to allocate nurses so there is a balance throughout the week? Have they factored in backup coverage in case of an influx in admitted patients? Does this person have the skills to design a schedule with the current staffing number and do they understand how to utilize each nurse’s skill set? Although there are many other factors to consider when discussing staffing issues, it would be challenging, and irresponsible to try and justify poor care to a person in an emergency situation. I believe as medical technology is ever changing, so will the needs of the patients coming to the hospital. We are seeing people live longer because of medical advancements, however, they are also presenting with a multitude of co- morbidities, which ultimately is more challenging to treat as a whole. As I continue my journey to becoming a nurse, I believe it will be in my best interest to keep the issues I discussed in the back of my mind. I’ll have the opportunity to experience clinical at different facilities, and ultimately will base where I want to work on how well a hospital considers the importance of adequate staffing and patient care. ReferencesRetrieved from from Network | JAMA | Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. (n.d.). Retrieved from ................
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