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Understaffing Nurses: The Patient’s and Personal Safety at RiskHaley PeckHonors European LiteratureAbstractThe following is an argumentative essay focusing on the understaffing of nurses, and the negative consequences it evokes. Understaffing Nurses: The Patient’s and Personal Safety at RiskProblemThe understaffing of nurses is a concern all states around in the United States, as well as across the world. When nurses are understaffed and forced to take on more patients than the regulated ratios, “The nurses were regularly assigned seven to nine patients at a time, when the safe maximum is generally considered four...” (Robbins, 2015), The moment a relative, or friend, steps into a facility with understaffed nurses they are at risk of injury or, worse, death. If nurses around the world are meant to care for ten or twelve patients a shift they are not able to provide care to the best of their abilities. Having this many patients for one nurse is what causes the increased risk of hospital injuries, “If you have several patients, and one is having a sudden hemorrhage and one is having chest pain and the other is having a stroke or is choking, you have to have enough nurses that can deal with each of those instances and not place one above the other” (Jacobson, 2015). The understaffing of nurses is no small issue considering when Paul Govern spent time researching forty-three units, for an article about patient mortality rates, he found “Some 15 percent of shifts were found to have below-target R.N. staffing of eight hours or more.” (Govern, 2011). This means that for eight hours, an entire nurse’s shift, nurses were providing rushed care. For these eight hours patient’s and nurses’ lives were at risk. Fifteen percent of the shifts scheduled in the forty-three units were made knowing the nurses would be understaffed. According to Deborah Burger, National Nurses United’s co-president said, “It happens all the time… nurses are harassed into taking what they know are not safe assignments…The pressure has gotten even greater to keep your mouth shut. Nurses have gotten blackballed for speaking up”(Robbins, 2015). Facilities employing nurses are aware of the fact that they are understaffing nurses and putting everyone involved at risk. The working conditions that nurses are put in are so unsafe that many know if the facility they work for was observed nurses would lose their licenses; “The nurses were scared because their department was so understaffed that they believed their patients — and their nursing licenses — were in danger, and because they knew that when tensions ran high and nurses were spread thin, patients could snap and turn violent” (Robbins, 2015). When facilities do not assign the proper amount of nurses to their patients they risk the chance of becoming more understaffed. In turn risking the physical and emotional well-being of nurses and patients.Not only is physical health at risk when it comes to understaffing of nurses, but emotional as well. Nurses are constantly in a position where they are open to patient’s emotions, and their wants and needs. Due to this nurses are taking in all of their patients emotions throughout the day causing a patient’s frustration leading to the nurse’s mood through the remainder of their shift. During Alexandra Robbins time shadowing various nurses, gaining research for her novel The Nurses, she discovered “Experts estimate that approximately 30 percent of nurses are burnt out…defined as a “loss of caring.” Burnout symptoms include irritability, difficult concentrating, low energy…thoughts of quitting…. ‘Compassion fatigue,’ also called secondary traumatic stress disorder, can occur when empathetic nurses unconsciously absorbed their patients’ stress” (Alexandra, 2015). Since nurses are understaffed when they perform care they know is rushed, causing a patient to lash out, they carry it with them throughout their shift.As mentioned previously nurses are fully aware that the care they provide is not complete or rushed due to understaffing. As a nurse being hands on with a patient allows for a personal connection to occur. Due to this connection many nurses experience when it comes to making a decision between patient health and personal health nurse will likely chose the latter. It has reached the point where nurses will spend their time away from their facility worrying about their patients instead of caring for themselves. Alexandra Robbins also gathered personal stories from nurses during her time shadowing for her novel The Nurses. In one of these stories a nurse shared, “about sleepless nights during which they were so worried about patients that they called the unit to check on them, and days off that they spent doing something for the patient instead of for their family” (Alexandra, 2015). Due to nurses using their personal time for work it results with nurses starting their shifts feeling fatigued, thus more likely to make mistakes in an already accident prone situation.Research has found that patients are the most at risk for injury, when nurses are understaffed. The patients, in a hospital setting, are waiting for hours before they are seen due to the understaffing of nurses. When facilities fail to accommodate adequate staffing for the amount of patients seen on an average day, they cause improper treatment. Imagine a relative or friend rushing to the hospital than being forced to sit and wait because proper staffing was not taken into consideration. On average by the time patients are seen by a professional they are preparing to leave. This type of staffing, in relation to hospitals, is most commonly seen when an attempt to increase efficiency is made. This restriction on hospital resources leads to an even greater understaffing of nurses, “…because if you constrain resources too severely, then some hospitals may decrease nurse staffing and inadvertently put patients at increased risk for mortality…” (Govern, 2011). Hospitals are becoming more concerned by with equipment they find useful instead of nurses that patients need.When patient lives are at risk form understaffing of nurses, the elderly are the most vulnerable. Paula & Perkins PA. reported in their Nursing Home Abuse Guide that “up to 91% of nursing homes in America are not sufficiently staffed to accomplish all caretaking tasks required by their elderly patients” (Paula & Perkins PA., 2015). The biggest sign of change needed should be the startling amount of understaffed nursing homes. Nursing home residents are there for the sole reason that they can no longer provide adequate self-care. Many patients in nursing homes need on or more nurses to transfer them from bed into their wheelchair. When nurses are understaffed a two person assist become one nurse putting themselves and the patient at risk of severe injuries. Elderly residents also needed to be repositioned every two hours to prevent pressure ulcers from forming. If a nurse has twelve residents during their shift, completing scheduled care will come before they realize a patient was left immobile for the past four or more hours. Elderly patients are more susceptible to injury and illness than most patients, because “…staffing levels fall below certain nurse-to-patient ratios, the patients are more likely to suffer or even die” (Jacobson, 2015). Elderly patients are the patients who need the most specialized care, yet nursing homes are the most understaffed facilities, when it comes to nurses.SurveyOn April 14 2015 Alexandra Robbins, author of The Nurses, publishes her following of a variety of nurses in different health care facilities in order to prove the unhealthy effects of understaffing nurses. During her time observing nurses during their everyday shift, Alexandra finds one nurse who says, “If it comes down to helping a patient to the bathroom or being able to empty my own bladder after eight hours, it’s going to be the patient every time” (Alexandra, 2015, pg 167) Many of the nurses in Alexandra follows share similar stories of not being able to provide care for themselves due to having more patients than they should; to care for.On May 28, 2015 Alexandra Robbins, author of The Nurses, releases a follow-up article based on her newly published book. During this article Alexandra focuses more on the percentage and statistics involving understaffed nurses, instead of the nurses’ personal stories. During the process of gathering statistics another problem was brought to light. Alexandra found that “It’s not unusual for hospitals to intimidate nurses who speak up about understaffing...It happens all the time, and nurses are harassed into taking...not safe assignments...The pressure has gotten even greater to keep your mouth shut” (Alexandra, 2015). This article shows that not only do the facilities know they are understaffing units, but that they do not care.Francine M. Parker EdD, MSN, RN & Ramona B. Lazenby MSN, RN, CRNP & Jennifer L. Brown B.S.Ed., M.Ed., Ed.S, Ph.D. all worked as a team to find a correlation between moral distress and nurses’ job satisfaction. In their health research journal the team defined moral distress as, “occurring when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” (Parker, Lazenby, & Brown, n.d.). In 2015 Paula & Perkins PA released an article connecting understaffed nursing facilities to patients suffering bedsores. While only elderly patients are mentioned in relation to understaffing valid points, such as “In addition to mobility concerns, bedsores are a common result of understaffed nursing homes. Medical recommendations state that elderly patients should be repositioned every two hours to prevent the development of bedsores” (Paula & Perkins PA, 2015) can still be found throughout the article.Roni Jacobson, a journalist for Scientific American, published an article in July 14, 2015 depicting how many medical facilities do not regulate the nurse to patient reaction leading to worse patient health. “Yet many nurses in the U.S. and worldwide say they are forced to make those uncomfortable assessments on a daily basis because hospital administrators do not want to spend the money needed for ample staffing” (Jacobson, 2015).In 2015 the American Nurses Association published an article focusing on who can benefit, and how, when nurses are adequately staffed during any given shift. This article can be viewed as a guide to what is possible if more facility properly staffed their nurses. In this article they American Nurses Association also explains why proper nurse to patient ratio has not be accomplished in the past, “Staffing solutions require leadership support and recognition to assure an appropriate number and skill mix of registered nurses who are able to deliver safe quality patient care” (American Nurses Association, 2015). On May 17, 2011 Paul Govern published a research article that relates the understaffing of nurses with patient mortality rates; among 43 units. This article offers evidence useful for a counter argument. This is due to the research showing low percentages of patient mortality, “...patient exposure to registered nurse understaffing was associated with a 2 percent overall increase in patient mortality” (Govern, 2011). While this article has a low percentage, the amount of patients in the 48 units was not specified.In 2010 the American Society of Registered Nurses published an article focusing on common injuries among nurses; and their statistical probability. Some types of injuries, or diseases, depicted in this news journal are back injuries, depression, tuberculosis, and HIV. It is said that “During their lifetime, 9.6% of nurses will suffer at least one major depressive episode” (American Society of Registered Nurses, 2010).ArgumentThe only way to counter the understaffing of nurses is for facilities employing nurses to enforce a nurse to patient ratio and employ more nurses. By nursing facilities doing this they will be creating a safer and happier work environment for both their employees and patients.In California regulating hospital staffing is mandatory due to a law set in 2004. California is also “the only one to set minimum nurse-to-patient staffing ratios—ceilings for how many patients a nurse can be held responsible for at a time, which vary by unit” (Jacobson, 2015). This development has lead to safer outcomes for patients such as, fewer falls, in-hospital infections, and more attentive patient care. Due to the staffing regulations in Californian hospitals patients were receiving complete care allowing for patients’ hospital stay to greatly reduce. Hospitals in California are not the only ones receiving these results. The American Nurses Association found that adequate staffing is “shown to…Reduce medical and medication error…Decrease patient complications..Decrease mortality…Improve patient satisfaction…Reduce nurse fatigue…Decrease nurse burnout…Improve nurse retention and job satisfaction” (American Nurses Association, 2015). While improving working conditions is a large benefit when properly staffing nurses, suicide prevention is the largest concern.Nurses who are overworked, due to understaffing, put a greater strain on themselves. In most cases “…CNAs are so understaffed that they feel overworked, stressed out, or they simply quit. Many CNAs fear that they may lose their CNA license if they continue to work in these understaffed…environments” Paula & Perkins PA., 2015). As mentioned previously nurses are susceptible to patients’ emotions and when an issue cannot be solve, due to having ten other patients per shift, the nurse is left with a feeling of moral distress. Moral distress is when there is a constant stream of unsatisfactory results weighing on a person. For a nurse whose sole job is to help others to the best of their abilities, providing rushed care take its toll; knowing their care offers little benefit. The American Society of Registered Nurses has found that “The average suicide rate for nurses is 0.11 deaths per 1,000. While this may not seem significant, consider that this is higher than the national average of 0.07” (American Society of Registered Nurses, 2010). To put nurse suicide into a better perspective female nurses are four times more likely to commit suicide than the average female. When nurses are understaffed larger death rates, amongst both patients and nurses, are unavoidable. As stated, multiple times, death is a common and serious outcome due to nurses being understaffed. If facilities continue to understaff their nurses the death rate will only become worse. The amount of patient needing medical attention will only increase with the population growth rate. In a New York Times article published by Alexandra Robbins, in response to her published book, she found that “In pediatrics, adding even one extra surgical patient to a nurse’s ratio increases a child’s likelihood of readmission to the hospital by nearly 50 percent” (Robbins, 2015). When a patient is admitted to any medical facility the care should be given fully to prevent the chance of readmission. Not only will the patient’s health take a toll from improper care but multiple hospital stays will cost the patient more than receiving proper care during the first stay. For general patients, rather than simply pediatrics, studies have found that when nurses are assigned more than four surgical patients during a shift the chance of death is thirty-one percent more than a nurse with a proper patient-to-nurse ratio.The ones who stand against employing more nurse, to counter act the understaffing of nurses, are the medical facilities that need nurses. Medical facilities are concerned with having better equipment to make procedures faster and simpler for the care team and the patients involved. Yet having faster equipment will mean nothing if there are not enough nurses to use it. Facilities need to become more concerned with hiring more nurses to operate the equipment they purchase than expecting the equipment to operate itself.Until facilities start properly staffing their nurses to compensate for the amount of patients being cared for the death rates will not decrease. Until a proper nurse-to-patient ratio is set up, worldwide, people will continue to lose family members and friends once they enter a hospital. Until facilities start caring about their employees and patients well-being nothing will improve. Until when people stand for safe working conditions patients and nurses are going to continue to perish. ReferencesAlexandra Robbins (April 14, 2015) The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital. First edition. Page range: 1-359. Retrieved from bfqmrqi&sig=QuWIaJRAQkQ-Z-dfAXBzCxmt4pg&hl=en&sa=X&ved=0ahUKEwjps7n9x8LJAhXI6x4KHVx-CjMQ6AEIJjAC#v=onepage&q=%22understaffed%20nurses%22%20%2B%20overworked%20-.com&f=falseAlexandra Robbins (May 28, 2015) We Need More Nurses. New York Times. Page A25. Retrieved from M. Parker EdD, MSN, RN & Ramona B. Lazenby MSN, RN, CRNP & Jennifer L. Brown B.S.Ed., M.Ed., Ed.S, Ph.D. (n.d) The Relationship of Moral Distress, Ethical Environment and Nurse Job Satisfaction. Online Journal of Health Ethics. Volume 10 Issue 1 Article 2. Retrieved from & Perkins PA. (2015). Understaffing and Bedsores. Nursing Home Abuse Guide. Retrieved From Jacobson (July 14, 2015). Widespread Understaffing of Nurses Increase Risk to Patient.Scientific American. Retrieved from Nurses Association (2015) Nurse Staffing. American Nurses Association. Retrieved from Govern (May 17, 2011). Nurse staffing levels linked to patient mortality risk. Vanderbilt University. Revived from Society of Registered Nurses (2010). Nurses at Risk. Nursing Today. Retrieved from ................
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