Developing Organizational Policies and Practices

Developing Organizational Policies and Practices

Access to health care is essential because it makes it possible for a patient to get into the health care system, access a health care facility, and acquire services from trusted health care personnel. When the process encounters challenges at any of the stages, then the experience is flawed. A flawed experience translates to positive patient outcomes not being achieved. Several problems exist in health care organizations and consequently affect overall service delivery.

Competing Needs

Mandatory Overtime

Nurses are more than often required to work for long hours due to nurse shortages in the facility. As a result, nurses are likely to offer services that are below the standard needed due to burnout (“Mandatory Overtime in Nursing: What You Need to Know | Bradley University Online”, n.d.). Exhaustion means that nurses working overtime have to result in unethical means to cope with the stress involved adequately. Using pills, for example, is a practice used by nurses in the health facility. The use of medicines is meant to relieve stress as well as body aches related to overworking. It, therefore, means that the nurse functions under an induced state, which automatically translates to possible malpractice.

Use of Unlicensed Assisting Personnel

Health care services are expected to increase as more people require them. The fact that the mortality rate of the older generation has reduced translates to a more significant number of the aged population requiring health services (Li et al., 2017). It is important to note that older people are more likely to suffer chronic diseases that require medical attention.  A shortage of nurses in this regard results in to use of unlicensed assisting personnel. Cost-cutting equally results in to use of nurses with minimal training who work under the supervision of registered nurses. Clinical nonlicensed staff requires less pay, thus fitting into the cost-cutting goal of the facility.

Policy That May Influence the Stressor

Policies that restrict mandatory working hours can influence the overwork issue in the health facility. It is important to note that overworking has adverse effects on patients. These include fatigue and lack of alertness due to lack of ample sleep. As a result, medical errors occur as well as a high likelihood of catheter urinary tract infections (Bae & Yoon, 2014). These errors lead to higher patient mortality rates and hospital-acquired conditions. State law policies that regulate or restrict working hours can positively influence overtime hours. State law work policies would allow a nurse to refuse mandatory working hours requests unless in cases of unforeseen emergencies (Bae & Yoon, 2014).

Cost-cutting and nurse shortages play a significant role in the use of unlicensed personnel. In this regard, the Affordable Care Act is meant to make health services affordable and accessible to everyone. The policy though significant should also focus on the effects of cost-cutting. In this regard, affordability concerning cost-cutting strategies could be reviewed. Cost-cutting not only affects resources and staffing, but it also affects the quality of service delivery. Practical cost-cutting strategies would thus deal with the use of unlicensed personnel in attempts to lower cost. As more people access health care services, more staff is needed to deal with the rising numbers adequately. Quality of health is highly compromised by the use of unlicensed personnel.

Policy’s Strengths and Challenges in Promoting Ethics

The Affordable Care Act policy affects the health care sector in a positive manner. Affordable, accessible, and quality health care is the goal of the plan (Salmond & Echevarria, 2017). In line with the mission, more people have access to health care services through affordable insurance cover. More people in the low-income bracket, for example, have access to health services. The challenge, however, remains as access does not necessarily mean quality service. Disparities based on race, ethnicity, and income exist in health care service delivery. Racial and ethnic biases exist for minority groups as far as health care service access is concerned (National Academy of Sciences, 2003), which is unethical. Such disparities pose a challenge to the ACA policy as medical ethics in service delivery are not promoted.

Working hours policies legally dictate the number of hours nurses should work. Medical errors hamper ethical nursing practice. The policy thus positively affects patient outcomes. Working hour policy may suffer challenges due to medical personnel shortages in the health care facility. A need for licensed personnel for more complicated medical cases would require working overtime. Working within the stipulated hours could result in adverse patient outcomes. Implementing the policy would suffer challenges in this regard. Performing outside of the scope of practice in which service delivery is flawed is unethical. Positive patient outcomes translate into the promotion of good nursing ethics.
Recommended Policy or Practice

The working hour’s policy is highly recommended as far as overworking is concerned. The policy, however, has to factor in other underlying issues such as clinical and nursing personnel shortages. The ACA policy is also recommended since more people have access to health care services. The focus should, however, be given to the quality of services rendered to implement the policy adequately. In this regard, the use of unlicensed personnel should be discouraged with the aim of promoting quality patient service.

Ethical Shortcomings of the Existing Policies

The ACA policy has ethical shortcomings in its biased health service access. Insurance cover and income play a significant role in the existence of these biases. As intimated earlier affordability, neither equates to access nor quality. As such, bias promotes ethical shortcomings. Inadequate health care coverage is a massive barrier to health care access (“Access to Health Services | Healthy People 2020”, 2020). As a result, health needs are not met. Unnecessary hospitalization also occurs after prolonged unattended health problems. Hospital admission could be avoided if there were affordable and quality access to health care services. Delays in accessing services could also lead to aggravated health complications. All these outcomes are highly unethical since they are indicative of adverse patient outcomes. The scenarios are also avoidable, making it an ethical issue as far as health care service delivery is concerned.

The working hour’s policy, which regulates nurse working hours, could also result in negative patient outcomes. Adverse outcomes are likely in situations where the facility has a shortage of nurses. Due to policy implementation, the facility is expected to result in using unlicensed personnel to fill in the existing gap. The use of unlicensed personnel could lead to low-quality service, which is equally unethical since it realizes adverse patient outcomes.

Conclusion

Health care services have improved over the last years. However, there is still a lot to be done as far as insurance coverage and disparities are concerned. Addressing the two challenges would go a long way in realizing positive patient outcomes. The availability of resources and workforce would equally go a long way in achieving positive health care service outcomes.  It may take time to achieve the ACA goal, for example, but with political and stakeholder goodwill, it is possible.

References

Access to Health Services | Healthy People 2020. Healthypeople.gov. (2020). Retrieved 26

February 2020, from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services.

Bae, S., & Yoon, J. (2014). Impact of States’ Nurse Work Hour Regulations on Overtime

Practices and Work Hours among Registered Nurses. Health Services Research, 49(5), 1638-1658. https://doi.org/10.1111/1475-6773.12179

Li, S., Pittman, P., Han, X., & Lowe, T. (2017). Nurse-Related Clinical Nonlicensed Personnel in

U.S. Hospitals and Their Relationship with Nurse Staffing Levels. Health Services Research, 52, 422-436. https://doi.org/10.1111/1475-6773.12655

Mandatory Overtime in Nursing: What You Need to Know | Bradley University Online. Bradley

University Online. Retrieved 26 February 2020, from https://onlinedegrees.bradley.edu/blog/mandatory-overtime-what-you-need-to-know/.

National Academy of Sciences. (2003). The Health Care Delivery System. Ncbi.nlm.nih.gov.

Retrieved 26 February 2020, from https://www.ncbi.nlm.nih.gov/books/NBK221227/.

Salmond, S., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for

Nursing. Orthopaedic Nursing, 36(1), 12-25. https://doi.org/10.1097/nor.0000000000000308