This time it's all about my ideas......no references here. I think that California has started in the right direction with a mandated nurse patient ratio, but I am not sure that this is enough. We need to create an atmosphere that encourages nurses to stay, that fosters professional development.
We need to encourage education. I believe that we need to move to at least a bachelor's educated nurse level - but not all at once. The diploma and associate degree registered nurses are integral parts of the field. I believe that legislature should be passed to make it necessary to have a bachelor's degree within 5 years of entering the workforce (or 5 years of the passage of the law). I said no references, but some studies have shown that there were fewer patient complications when patients were taken care of by bachelor level nurses versus diploma or associate level.
Get rid of mandatory overtime. For a lot of nurses (and ancillary staff) this is a major bone of contention. More than taking them away from their families, friends and lives, it adds to the pressures of their jobs - both physically and mentally and speeds up any burnout that might occur.
Working together to increase staffing levels where possible and where not possible working together to ensure that the assignments are evenly distributed according to ability. Meaning - you have 4 nurses for 40 patients and 4 vented patients but 2 of your nurses are brand new, just out of school and the other 2 are veterans with 10 or 15 years under their belts. It may mean a little more work for the veterans, but ultimately better and safer patient care for them to split the vents and show the new nurses what to do. This is fostering growth and the next time, these nurses will be able to handle the cases. The new nurses will appreciate this and remember it when it comes their turn to teach down the road.
Increase numbers of teachers teaching in nursing schools. The problem with enrollment in nursing school is not that there are not enough qualified applicants, it is that there are not enough qualified professors willing to do the work! To me, it is a sad state of affairs when you can make more money doing the job than you can being the professor. We need to encourage colleges and universities to have the salaries of the professors competitive with the hospitals in their areas. This would then draw otherwise hesitant "professors" encouraged to join the ranks, enhancing enrollment, enhancing the ranks of the registered nurse!
There is the idea that we could move to a universal healthcare provider. This would decrease administrative costs by almost 30% thus opening these monies up to my next idea which is....
Then there is always hire, hire, hire! Hire RNs, LPNs, and UAPs and make the mix appropriate to the mix of patients.
16 October 2007
13 October 2007
Effects of Short Staffing
Short staffing can have many ramifications. One of the most well studied and most disturbing effects of nursing short staffing is an increase in “adverse patient outcomes... sensitive to nursing care” such as “urinary tract infections (UTIs), Pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays, failure to rescue, and 30-day mortality” (Stanton, 2004). Stanton (2004) goes on to say that other outcomes related to nursing staffing are lung collapse, pressure ulcers, and falls. Another effect of short staffing is higher workload and job dissatisfaction. In recent years there has been an increase in patient acuity and yet there has been no change in ratio of nurses. This leads to increased job dissatisfaction – according to Stanton (2004) 40 % are dissatisfied with their position as opposed to the 10 – 15 % of other professionals! Higher workload and dissatisfaction lead to “burnout” which leads to nurses leaving the field – an already understaffed and decreasingly staffed field losing competent and valuable professionals! In an article complied by McClure and Hinshaw (2007) it was stated that eliminating RN positions leads to higher turnover, higher disability, more malpractice lawsuits and bad publicity. This is only another example of short staffing having a circular effect on nursing. The unit is short staffed and so nurses are overworked, causing them to “burnout” and leave the field, thus causing more short staffing. There must be a better way.
References:
McClure, Margaret L., Hinshaw, Ada Sue (ed.)(April 2007). Spotlight On Nurse Staffing, Autonomy, and Control Over Practice. American Nurse Today, 2 (4), 15-7.
Stanton, Mark W. (2004) Hospital Nurse Staffing and Quality of Care. Research in Action. Retrieved September 18, 2007 from http://www.ahrq.gov/research/nursestaffing/nursestaff.htm
04 October 2007
What is short staffing?
According to a 2006 Gallup poll the most honest profession is nursing (Cohen, 2007). And according to a search on Google, the top five returns will give you registered nurses (RNs) as either the first or the second most respected in the WORLD. Everyday we are on the frontline of patient care, making a difference in people’s lives. This is an image that nurse’s value and cherish. But this image is hard to maintain and one of the biggest factors fighting against nurses and one of the hardest to control is adequate staffing.
Most RNs call inadequate staffing ‘short staffing.’ But there is no set definition of short staffing. One definition could be “Short staffing is when the tasks to be completed on a shift are not completed because there is not enough staff available” (“Staff Scheduling When You Are Continuously Understaffed”). Other definitions usually include the hospital’s definition of adequate staffing before deeming it inadequate staffing, which is why I prefer the previously mentioned definition. Not all hospitals have appropriate staffing levels to begin with. When an RN is caring for between 8 and 10 medical-surgical patients and the hospital has stated that this is an appropriate staffing level, I would have to disagree with the hospital’s stated policy. This is a situation where it is possible that not all of the tasks that are scheduled to be completed on a shift will be completed. There will just not be enough time or manpower, making this a short-staffed situation. The New York State Nurses Association (2005) states in their position statement that Joint Commission on Accreditation on Healthcare Organizations describes effective staffing as “…providing optimal numbers of competent personnel with the appropriate skill mix to meet the needs of an organization’s patients based on their mission, values, and vision.” These definitions, however, are generic and subjective and therefore, leave a lot open to interpretation. There needs to be a better definition of safe or adequate staffing for there to be a better definition of short staffing.
References:
Cohen, Shelley (May 2007). The Image of Nursing. American Nurse Today, 2 (5), 24-6.
Board of Directors (2005). Position Statement: RN Staffing Effectiveness and Nursing Shortage. Retrieved September 18, 2007 from http://nysna.org/practice/positions/position13_a.htm.
Staff Scheduling When You Are Continuously Understaffed. Retrieved September 25, 2007 from http://www.btinternet.com/~vrota/understaffing.htm.
Most RNs call inadequate staffing ‘short staffing.’ But there is no set definition of short staffing. One definition could be “Short staffing is when the tasks to be completed on a shift are not completed because there is not enough staff available” (“Staff Scheduling When You Are Continuously Understaffed”). Other definitions usually include the hospital’s definition of adequate staffing before deeming it inadequate staffing, which is why I prefer the previously mentioned definition. Not all hospitals have appropriate staffing levels to begin with. When an RN is caring for between 8 and 10 medical-surgical patients and the hospital has stated that this is an appropriate staffing level, I would have to disagree with the hospital’s stated policy. This is a situation where it is possible that not all of the tasks that are scheduled to be completed on a shift will be completed. There will just not be enough time or manpower, making this a short-staffed situation. The New York State Nurses Association (2005) states in their position statement that Joint Commission on Accreditation on Healthcare Organizations describes effective staffing as “…providing optimal numbers of competent personnel with the appropriate skill mix to meet the needs of an organization’s patients based on their mission, values, and vision.” These definitions, however, are generic and subjective and therefore, leave a lot open to interpretation. There needs to be a better definition of safe or adequate staffing for there to be a better definition of short staffing.
References:
Cohen, Shelley (May 2007). The Image of Nursing. American Nurse Today, 2 (5), 24-6.
Board of Directors (2005). Position Statement: RN Staffing Effectiveness and Nursing Shortage. Retrieved September 18, 2007 from http://nysna.org/practice/positions/position13_a.htm.
Staff Scheduling When You Are Continuously Understaffed. Retrieved September 25, 2007 from http://www.btinternet.com/~vrota/understaffing.htm.
01 October 2007
My Purpose
The purpose of this blog is to explore what I believe is one of the most difficult aspects facing nursing. Being short staffed. It is an issue that nursing has struggled with in the past, struggles with today. It is an issue that is not going away either. According to research, it is forecast that the demand for registered nurses will exceed the supply by about 20% by 2020 (Lin and Liang, 2007). I feel that this is a topic that needs to be discussed and I will be discussing what it is, why it is a problem, and what I feel we should be doing about it. Discussion is greatly encouraged as this effects us all - registered nurse, licensed practical nurse (or licensed vocational nurse), nursing assistant, patient, doctor, whomever!
Reference:
Lin, Laura & Liang, Bryan A. (January – March, 2007). Addressing the Nursing Work Environment to Promote Patient Safety. Nursing Forum, Volume 42, Number1. Retrieved September 18, 2007 from http://www.nursingadvocacy.org/faq/short-staffed.html.
Reference:
Lin, Laura & Liang, Bryan A. (January – March, 2007). Addressing the Nursing Work Environment to Promote Patient Safety. Nursing Forum, Volume 42, Number1. Retrieved September 18, 2007 from http://www.nursingadvocacy.org/faq/short-staffed.html.
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