Pulling Nurses: A Case Study

I am very fortunate to be serving as a Registered Nurse (RN) in our community for the past 17 years. For years, my RN colleagues here in Michigan have expressed frustration and concern when working chronically understaffed shifts and the when using mandated overtime to cover staffing shortages. Safe staffing levels

The word “Selfish” is a term that most people do not want to be identified as. The word is often associated with negative characteristics. Jon Krakauer explores selfishness within Chris McCandless in Into the Wild. Chris was a good man, but when he met people along his travels, he left them without notice. He was self-indulgent and dismissed good opportunities for his future. Chris also completely abandoned his family, leaving them worried sick about him. Chris McCandless’s quest for ultimate freedom was done selfishly - concerned only about himself, and disregarded the feelings of the people around him.

Understaffed nurses can cause longer stay and increase the readmission rates because patients don't get enough education for discharge preparation, and information about how to take care and manage their diseases based on evidence based practice. A study of Marquette University in Milwaukee found that with fully staffed units, patients were unlikely to come back within 30 days. This decreasing of readmission rate happened because when nurse don't have high workload, they can have time to do more effective education for patients about care coordination while they are staying in the hospital or effective discharge planning (Klein, 2011).

Nurses find themselves in the middle of a complex health care system between the financial side and patient safety. A professional nurse’s goal is to provide safe, quality, patient care. However, nurses often fail to meet this goal due to the variability in patient acuity, the unpredictable workload of nurses, and institutional budget constraints (ANA, 2014). According to the American Nurses Association (2014) research shows that lower staffing levels of registered nurses correlate with poor patient outcomes, as well as negative nurse outcomes, such as physical injury and ‘burnout.’

Thus the support of the Vice President of Nursing is necessary for this project. As inconsistencies exist between managers, a third strategy to improve the scheduling gap is to form a Nurse Staffing Advisory Council. This Council membership will include frontline nurses and nurse managers. The Vice President of Nursing will head the team. Dent (2015), mentions that the Chief Nursing Office is a valuable asset to this council. The responsibilities of the Council are to assure a fatigue management policy is in place, consider nurse-sensitive outcomes in evaluating staff adequacy, and assure the self-scheduling policy is in place and rules are being followed. Also, this team will be responsible for writing a staffing plan which will include minimum staffing requirements for the nursing units along with a volume surge management

Working with the available staff increases the nurses’ workload and the risk for patients’ negative outcomes. Heavy nursing workload adversely affects patient safety and negatively affects nursing job satisfaction (Carayon & Gurses, 2008, p. 1). Furthermore, a study on the hospital nurse shortage and the California legislation about minimum hospital patient-to-nurse ratios concluded that the nurse staffing levels affect patients’ outcomes detrimentally; for each additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission and a 7% increase in the odds of failure-to-rescue. In addition, this study concluded that 23% of the nurses were associated with burnout and a 15% increase in job dissatisfaction (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002, p.

The American Nurses Association supports a legislative model in which nurses are encouraged to create staffing plans specific to each unit. This approach will aide in establishing staffing levels that are flexible and can be changed based on the patients needs, number of admissions to the unit, discharges and transfers during each shift (“Nurse staffing plans,” 2013). This model will assist in keeping the unit staffed appropriately and organized in need of a change during each shift. Without an organized plan like this, a nurse may be required to take on a new admission and already have too big of a workload.

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

When was the last time you were in the hospital or a loved one was in the hospital, and ever wondered where the nurse is, and they haven 't returned for hours. You finally push the assistance button several times, and they open the door and hurriedly say, “I will be right back”, then you don 't see them for a while again. When they come back to check up on you, you explain to them what you need, and then they send in a less qualified staff member to assist you. At this point, you become very annoyed and frustrated not to mention scared to be admitted in the hospital to begin with. Little do you know, your nurse has ten other patients and other non-nursing tasks that they are responsible taking care of. They have been working a double shift and are extremely exhausted, and a large stack of charts that they will have to do before their shift is over. As a patient, you now become frustrated and are not happy about this; as a nurse, they are just as frustrated as you are, not only because the amount of work they have but more importantly they can 't deliver the appropriate care they long to give. For most hospitals they do not hire enough registered nurses for reasons that are good and bad. This is an issue that needs to be addressed not only locally but nationally and on a constant basis. When there are too many patients for one registered nurse to attend to, nurses become exhausted, mistakes are made, and patients are unsatisfied. A minimum nurse to patient ratio needs to be

Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in

Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.

A nurse’s typical day isn’t without stress; it is usually a lot of complex planning, critical thinking, time management, an abundance of communications with all departments of the hospital, and documenting events that have happened throughout the day on their entire patient assignment. “Nurses who are mandated following the completion of their regular shift are often ill-equipped to continue working. They have not planned for that situation with: proper advanced rest, arrangements for

Nursing shortages have always occurred in cycles. Recently, the shortage has become worse due to the implications of managed care as a way of controlling escalating health care costs. While the shortage did ease some during the recession of 2009, there is still a shortage in some areas of the country (Cherry & Jacob, 2014). Increased student enrollments and government policies have helped with the shortage, but the occupational outlook for nursing jobs is expected to grow faster than any other occupation through 2018. So it is essential that the supply of nurses increases to keep up with the demand. The current shortage is due to several factors. First, new nurses are needed to replace “baby boomers” who will be retiring in the near future. Second, as the population ages, there will be a demand for more healthcare, leading to a demand for more nurses. Third, new advances in patient care will lead to more people in the healthcare system needing more specialized care, and lastly, the affordable care act places a large emphasis on preventive care, leading to more people desiring wellness visits (Cherry & Jacob, 2014). Finally, according to Dall’Ora, Chiara, Griffiths, Peter, Ball, Jane, Simon, Michael Aiken, Linda H. (2015), “shifts lasting 12 hours or longer were associated with a 40 percent greater level of job dissatisfaction and a 31 percent higher risk of planning to quit. Job satisfaction and burnout in the nursing workforce are global

The first topic focused on in an article by Stimpfel et al. (2012) looked at the effect of longer shifts on nurses. Compared to the past, nurses are working twelve-hour shifts, instead of eight-hour shifts. The reason for these changes in shift lengths is for it to allow for nurses to have more flexibility in their schedules and to give them more time at home. This study revealed that the hours actually worked by nurses are unpredictable. Due to the fluctuations of patient needs and unanticipated staffing on the unit, leads to nurses having to work over their scheduled time (Stimpfel et al. 2012). This study also pointed out that there are no national policies for nurses that dictate the maximum number of hours a nurse can work. Nurses often end up working several hours over their shift because they feel forced into working those hours and thereby leading to burnout.

A continuous concern that continues to present itself within the healthcare environment is adequate staffing on nursing units. Most hospital organizations try their very best to accommodate staffing needs, though many units remain understaffed for an unspecified amount of time. Inadequate staffing can negatively affect patient outcomes, lead to nurse burnout, and decrease patient satisfaction scores. Combating this issue will require a great deal of effort, as many geographical face nursing shortages when seeking new graduates and qualified candidates. Employees may begin to feel that they are unable to pursue personal goals within a healthcare organization, due to inability to transfer as a result of staffing shortages. This often results in nursing seeking employment or career advancement outside of the organization or geographical area, which further intensifies ramification associated with inadequate staffing.