Challenge in the nursing field
by Elizabeth Kroll – Monday, February 17, 2020, 9:53 PM
Number of replies: 3
I am a brand-new nurse and have not yet worked alone on a unit. I have worked as a Certified Nurse Assistant and during clinicals on units in which I have witnessed red flags with respect to safe staffing. While working as a CNA there were many times where I felt the patient ratios were unsafe. There were times when the primary nurse I worked with had 7 patients; therefore it was very hard for me to pull them away immediately when I noticed a change in a patients condition, or needed help transferring a patient safely who was considered a “two-assist”.
A specific situation that comes to mind, while working as a student nurse, there was a disgruntled patient who had not received his medications right at 9pm as he wished. His nurse had 7 patients and was making her rounds. He began yelling, which escalated to cursing at staff, which escalated to him threating to leave or call the police. When his nurse walked in the room with his medication, she was as pleasant as possible explaining that medications can be administered in a 1-hour window. The only thing I would have done differently as his primary nurse would be to stop in his room and try and explain that I had not forgotten about him and would be with him as soon as I finished taking care of another patient. No steps were taken to prevent this scenario, as I feel and have seen working as a CNA that this is a common scenario. There are patients who expect 1:1 nursing care, which is unfortunately just not possible.
I am a proponent of mandatory, inpatient nurse to patient staffing ratios. I do not agree that specific ratios need to be implemented on a federal basis, but that individual hospitals should analyze the level of care of their patient population and set ratios based on level of care and treatment available at that institution. One suggestion I researched stated, “proponents of mandatory, nurse-to-patient staffing ratio laws consider the alternative of improving staffing levels by reimbursing nursing care based on the intensity of the care given” (Welton, 2007). There is much debate on this topic as many fear costs would skyrocket and there would be no guarantee for quality improvement and an increase in positive outcomes.
I did find an article on the American Nurses Association website stating that the ANA “applauds” the introduction of The Safe Staffing for Nurse and Patient Safety Act. This act was introduced to the Senate and House in 2018. It required Medicare-participating hospitals to form committees that are compromised of at least 55% direct care nurses with the goal to create and implement unit specific nurse-to patient ratio staffing plans (McClendon & Farbman, 2018). I think that adding RN’s to unit staffing decisions is an excellent idea.
References
McClendon, S. & Farbman, R. (2018, February 22). ANA Applauds Nurse Staffing Legislation. Retrieved from https://www.nursingworld.org/news/news-releases/2018/ana-applauds-nurse-staffing-legislation/
Welton, J., (2007, September 30). Mandatory Hospital Nurse to Patient Staffing Ratios: Time to Take a Different Approach. OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 3, Manuscript 1. Retrieved from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/Mand
Response
Hi Elizabeth, safe staffing remains to be a challenge in the nursing field, as you have pointed out. When nurse-patient ratio is compromised, it translates to poor quality care provided to patients. Curley (2018), argues that nurses’ vigilance as they attend to patients directly relates to their capability to ensure patient safety. However, the challenge, nurses who attend to patients should communicate, so that patients do not feel neglected as in the scenario you gave. Also, each healthcare facility should deploy its nurses according to the needs of each patient, and the workload of each unit. As governments seek to solve the issue of the nursing shortage, it should also strive to retain nurses within the profession to prevent the worsening of the problem. According to Yarbrough et al. (2017), one out of five nurses leaves the profession within the first year of acquiring licensure due to burnout and job dissatisfaction. So, the government should try and provide a conducive working environment for nurses as it tries to solve the nurses shortage.
Reference
Curley, M. A. (2018). Patient-nurse synergy: optimizing patients’ outcomes. American Journal of Critical Care, 7(1), 64.
Yarbrough, S., Martin, P., Alfred, D., & McNeill, C. (2017). Professional values, job satisfaction, career development, and intent to stay. Nursing Ethics, 24(6), 675-685.
by Shelly MacGregor – Tuesday, February 18, 2020, 8:19 AM
Number of replies: 2
The Operating Room (OR) is a unique unit to work on and shortages are usually caused by sickness, vacations, or injured coworkers. With this in mind, there are only two of us nurses that work night shift solely and daylight shift nurses do not like to cover night shift because you are the only nurse and you must deal with any situation that presents itself. There are a lot of traumas on night shift and it can feel as though you are covering about 3 or more jobs. You are the secretary taking postings for the next day, the preoperative nurse getting the patient ready with signing consents and such, as well as, getting the OR suite ready for any procedure that is coming in. It can be quite a daunting shift sometimes. Recently, my fellow night shift nurse had the flu one week and a knee injury the next week. My daylight shift Charge Nurse asked me to cover the extra shifts which put me into overtime. I was a bit upset about covering so many shifts, but it was what was asked of me, so I obliged. I had the right to ask for help but was willing to cover what was needed. This statement really made me think of my situation, “Nurses are also people who have their own needs and should have their rights.” (Kangasniemi, M., Stievano, A., & Pietila, A., 2013).
If I was put in this situation again, I think I would ask the daylight Charge Nurse to cover a few of the nights with daylight shift nurses because, I was beat by the end of that stretch of work. Mandatory staffing would not have helped in this situation, but if this situation ever takes place again, I think I would ask for a 3-11 shift to be made so that I am not working 4 or more 12 hour shifts in a row. There were no steps set in place to keep this situation from happening again. Thankfully, I was rewarded with extra payment for my extra hours and verbally praised by my superiors. With all this in mind I am reminded of the fifth right in the Nurses Bill of Rights written by the ANA that states, “Nurses have the right to fair compensation for their work, consistent with their knowledge, experience and professional responsibilities.” (ANA,2020).
References:
American Nurse Association (ANA), n. d., (2020) Bill of Rights, Retrieved on February 18, 2020 from: https://www.nursingworld.org/practice-policy/work-environment/health-safety/bill-of-rights-faqs/
Kangasniemi, M., Stievano, A., Pietila, A. (2013). Nurses Perceptions of their Professional Rights. Nursing Ethics 20(4), 459-469.
Response
Hi Shelly, it is said that you had to do that much to ensure the safety of your patients. However, as Kangasniemi et al. (2013) state, nurses often forego their needs while attending to patients, thus compromise their wellbeing. Working for all those hours in the operating room, where there is a lot of work, contributes to burnout, which then translates to poor patient outcomes. This is because the nurse is physically, mentally, and emotionally exhausted. However, patients cannot be left unattended due to incidences such as other nurses being sick or injured because most of the time, surgical emergency cases arise at night, and saving lives is one of the objectives of every nurse (Kandula et al. 2019). As staffs work extra hours, however, organizations and managers should recognize their efforts to motivate them to ensure patients will be safe regardless of the team available and that nurses do not suffer because of being overworked.
Reference
Kangasniemi, M., Stievano, A., Pietila, A. (2013). Nurses Perceptions of their Professional Rights. Nursing Ethics 20(4), 459-469.
Kandula, M., Karthika, P., & Abraham, R. (2019). Nurses Action towards Cardio Vascular Emergencies. Asian Journal of Nursing Education and Research, 9(1), 121-126.