Nursing Shortage and Quality of Care
The need for more registered nurses continues to rise as we now come to face an increase in the geriatric population that is the “Baby Boomers” - Nursing Shortage and Quality of Care introduction. The safety and quality of patient care is directly related to the size and experience of the nursing workforce. Nurses work in a variety of conditions that may not be preferential because hospitals have not kept up with the rising demand for nurses. As a nurse assistant, staff nurse, charge nurse or nursing administrator, inadequate staffing creates tension and stress.
When staffing is inadequate patient safety, infection rates, patient satisfaction and staff satisfaction are only a few of the areas affected. Many hospital administrators and lawmakers want to make patient care a numbers game. According to Morgan (2004), The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to create a staffing plan that defines staffing effectiveness as the skill mix, competence, and effectiveness related to the services needed.
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Patients are individuals with individual needs and one patient with a certain diagnosis can take much less attention and time from the nurse than a patient of the same age with the same diagnosis. The notion that high-quality care in hospitals is essential to the public safety needs is not a new theory. Nursing leaders are under tremendous pressure to lower costs while improving quality. It is often found that hospitals during low census times or times of budget cuts will try to let ancillary staff go and assign their duties to the nurse caring for the patient.
Nurses can replace several other positions in a healthcare setting but no other position can replace the nurse. Acuity versus Nurse to Patient Ratios Legislatures, health care providers, and the public are demanding adequate staffing ratios for nurses, particularly RN’s to patients in an acute care setting (Huston, 2010, p. 165). These measures assign some minimum level of staffing that all hospitals must meet regardless of the types and severity of patients. There are many reasons why staffing by acuity or nurse-to-patient ratios should not be solely mandated by lawmakers.
Direct care nurses should be involved in staffing decision. Outcomes are better when nurses have control of their workload (Anonymous, 2005). Adequate staffing must be priority for anyone involved in healthcare. There will always be pros and cons to mandated nurse to patient ratios but, the focus needs to remain on the safety and health of the patient population. With our aging population and the increased age of the baby boomer generation nurses are going to increase in demand. Healthcare is changing so quickly and this also affects the shortage.
The average acuity of patients has increased over the last decade while the nursing shortage continues. Too many lawmakers are paying attention to suggested staffing formats and not really addressing the overall need to increase the nursing workforce in numbers in order to provide safe and effective health care to the patient population. Whether by acuity or ratios, for each nurse to take fewer patients we will definitely need more nurses. Staffing by Patient Acuity Staffing by acuity is a format used to decide how many nursing hours are needed for certain diagnosis or types of patients.
Typically areas within a healthcare facility where patients are less ill can have nurses caring for as many as seven patients at a time because their acuity score is much lower than a patient in the intensive care unit or a step-down unit. Healthcare systems that utilize staffing by acuity are looking at the safe number of certain levels of patients that one nurse can care for. The down side to staffing by acuity is that many feel administration will influence numbers to maintain a high number of patients per nurse.
Acuity does not take every patient encounter into consideration. For instance a dementia patient may have a low acuity based on the nursing care since they usually do not have indwelling lines or invasive procedures. Although the same patient may require a high amount help with activities of daily living, decision making and education. (Walsh, 2003) Thus staffing by acuity can be a subjective form of nurse staffing. California: Staffing by Mandated Nurse to Patient Ratios Nurse-to-patient ratios are a concept that mandates a certain number of patients for each nurse to care for.
Depending on the types of patients being cared for this number can differ. California has a law requiring nurse-to-patient ratios that are to be followed in acute care facilities. This law was signed in 1999 but was unable to be implemented for another four years. California state guidelines say that medical-surgical patients are one to five and in the intensive care units ratios are one to one. California has at the same time seen many issues related to the ratios law. Ratios can cause longer transfer times for patients, increased ER bypass and postponed elective surgeries.
California has experienced 12 hospital closures and downsizing of services since ratios was implemented. Patients are not all alike, their needs are individually different. Nursing units are different and ratios do not take into account the nurse’s level of experience or the physical layout of the unit. Opinion I believe that patient to nurse ratio could be a valuable asset to decrease accidents, staff burnout, and job dissatisfaction. At the same time, ratios can also be beneficial to provide a more comprehensive level of care for the assigned patients.
Since ratios can have some “pros’ and some “cons”, I feel that the more proactive approach would be to combine both aspects of the acuity level and the actual patient census per the unit or facility. Facilities that only used an improvised method of acuity in order to assign staffing will lead to nurses who feel overwhelmed. On the other hand, if acuity is not taken into account at all, then the patients are put at a higher rate for complications, accidents, and decreased mortality rates. There are several states and some countries that have adopted this legislation.
Some legislatures have even established a law that goes a little further by establishing a hospital wide nursing care committee. This committee will recommend a nursing service staffing plan according to the facility’s assessment of patient care needs (Huston, 2010, p. 173). Other states call for at least an annual evaluation of the staffing plan. These are just some of the alternatives. All states should consider the effect of how this will impact the nurses and the patients. If the patients and nurses are satisfied, the health care system will benefit and the patients alike will all benefit in the end.