Ethical Implications of Inadequate Staffing in a Health Care Organization

Ethical Implications of Inadequate Staffing in a Health Care Organization

In nations across the globe, patient experiences are being evaluated to acquire information regarding the quality and delivery of healthcare services. A patient’s experience can be described as the reflection of what happened during the care process and thus offer information regarding the performance of healthcare staff. In Europe and also the United States, assessment of patient experience is part and parcel of a systematic survey. Assessment of patient experiences regarding the quality of care does not only offer information regarding the real experiences but also brings forth the quality aspects that patients deem as most essential. When healthcare facilities evaluate the patient experiences, healthcare professionals can use the findings in the improvement of internal quality. Further, professionals utilize patient preferences and experiences to adjust their practice and also, to make their contributions to the patient outcomes visible. Since nurses spend much of their time with patients, they significantly impact patient experiences. Studies show that the nursing work environment is a critical factor. Inadequate staffing makes it hard for healthcare professionals to undertake their ethical responsibilities (Gabriele, 2011). Due to the shortage of nurses in healthcare facilities, nurses exhibit job dissatisfaction and emotional distress and eventually end up not offering quality care to their clients. As such, the nurses find themselves in ethical dilemmas, where they have to decide on whether they should care for the welfare of their clients or their own. This paper seeks to analyze the ethical implications of inadequate staffing in healthcare as well as offer strategies to aid in the planning for and avoiding inadequate staffing.

Ethical Implications of Inadequate Staffing in a Health Care Organization

Morally, in acute-care settings, there is a burden to seeing the suffering of a patient and trying to find a balance between the benefit against the suffering, and the multi-faceted nature of the decision that needs to be made. From an ethical point of view, with regards to inadequate staffing in healthcare, the questions that need to be answered are, “what is the right thing to do?” and “on what grounds does it seem so?” Drawing reference to one of Grice’s maxim, quantity, which implies that one should make his or her contribution as informative as needed and not delve in a lot of details to drift away from the conversation. Therefore, in a conversation, one has to be as relevant as possible. However, succinctly put, the maxim seems to be problematic when it comes to matters of staffing. The experience of healthcare staff, the number of patients, the specializations of the staff, the type and amount of support staff, the organization’s architecture, patient acuity, among other things, have an impact on what adequate staffing means. From research findings conducted over the previous years, it is correct to assert that something like the ratio of registered nurses (RNs) to patients improves care, and the experiences and education levels of the healthcare professionals also increases care.

The American Nurses Association asserts that the existence of adequate staffing in healthcare organizations reduces medication and medical errors, reduces patient complications and mortalities, improves patient satisfaction, minimizes the healthcare professionals’ fatigue and burnout and, enhances employee retention and job satisfaction levels. Legally, the Federal Regulations (42CFR 482.23(b)), Medicare-certified healthcare organizations are required to have an adequate number of licensed RNs, vocational (practical) nurses, as well as other professionals who offer care as required (American Nurses Association, n.d.). Nonetheless, the provision is silent on what constitutes “adequate.” It is imperative to note that inadequate staffing exacerbates the shortage of nurses. The demand for nurses forces nurses to consider practicing as part-time nurses or work in other careers. Approximately 45% of the nurses who took part in a survey contended that they plan to change their careers within three years, with more than a third of those interviewed considered careers beyond nursing (Department for Professional Employees, 2019). Another implication of understaffing is the increased operational cost for healthcare organizations. For instance, the American Association of Colleges of Nursing estimates that the average cost-per-hire of a registered nurse is $2,820 (Department for Professional Employees, 2019). In other studies, it is approximated that the general turnover cost per registered nurse is $65,000 (Department for Professional Employees, 2019). Another research reveals that an average healthcare organization roughly loses around $300,000 annually for every percentage point increase in the annual nurse turnover (Department for Professional Employees, 2019). Alongside the enforcement of mandatory overtime, healthcare organizations usually make use of supplemental employees to fill the nurse staffing gaps temporarily. The temporary employees are more likely to be more in organizations that are understaffed and have inadequate resources. The supplemental employees are expensive, mainly when they are sourced from outside agencies. For instance, RNs are compensated at rates between 25-40% above the average wage of an RN (Department for Professional Employees, 2019). The rates of work-related injuries also increase in organizations with temporary employees.

Further, inadequate staffing also endangers the patients and healthcare professionals alike. The Bureau of Labor Statistics approximates that the demand for RNs is set to increase between 2016-2026 by 15% (Department for Professional Employees, 2019). The increased demand compounds the current staffing shortage. High patient to nurse ratios will result in fatigue, job dissatisfaction and emotional exhaustion which ultimately compromises care. Understaffing also exposes the professional to the risks of developing depression, hypertension and musculoskeletal disorders. Overtime and long working hours also compromise the professionals’ cardiovascular health. Also, inadequate staffing in hospitals is associated with accidental deaths, cardiac arrests, pneumonia, patient infections, medical errors, bedsores, and Methicillin-resistant Staphylococcus aureus (MRSA). Generally, the first ethics principle for healthcare professional is to do no harm (Kangasniemi, Vaismoradi, Jasper & Turunen, 2013) and as people always come first before anything. Saving money, making money and even losing money is not an ethical excuse for people to be harmed. If organizations are unable to afford healthcare service provision, then it is prudent not to put forth to the professionals and the public that the services can be rendered. There are exceptions where understaffing can be excused and can be limited to natural disaster and even war. Other exceptions need to be less and far between. There are no recommended ethical reasons which excuse sufficient staffing as anything other than rare exceptions to the rule. People who have anything to do with the provision of patient care have the responsibility for sufficient staffing.

Strategies to Help Plan for and Avoid Inadequate Staffing

Healthcare executives can approach the understaffing problem from two perspectives. One is by maximizing the efforts to retain and attract staff and the other is by increasing labor efficiencies. The two perspective support each other.

Increment of Labor Efficiency

This implies the achievement of more with less. What currently happens is that organizations attempt to focus on productivity by requiring the workforce to do much in a short time. Therefore, hospitals need to use their workforce efficiently other than burdening them. Streamlining of workforce workflow, facility can minimize the time invested in administrative duties such that employees experience low stress levels and have more time in delivering care. An important aspect in attaining this feat is through the optimization of process, enhanced management of personal proficiencies, as well as the investment on important technologies which are safe and reduce workloads. Standardization of procedures also helps in increasing labor efficiencies. Once a process is understood, a technological solution may be leveraged to streamline a process and incorporate disparate elements (HealthManagement, 2019). Thus, increasing of productivity is not in any way incompatible with increasing employee satisfaction. Appropriately established efficiency measures which are aimed at freeing up work time and minimize hours contributed to employee satisfaction.

Retaining and Attracting Excellent Staff

Staff turnover in healthcare is 30% higher that in other service industries (HealthManagement, 2019). The most cited reasons for employee turnover in the industry include relationship with colleagues and supervisors, excess workload and involuntary terminations. Through the definition of essential behavioral competencies, being better at interviewing applicants, and also utilization of behavioral assessment to assess behavioral competencies is one way of recruiting the best employees. Selecting the best employees is the first step of dealing with understaffing in healthcare. Clarification of work expectations during onboarding and recruiting; encouraging employee input on critical matters; support the development of their careers; train and place leaders who engage, value and develop the front-line employees; optimize schedule flexibilities; and lack tolerance on lateral violence. Such approaches are equally import to other members of the healthcare staff.

Conclusion

Ethics is all about trying to determine what is right in a certain situation. Inadequate staffing has negative implication in the industry like long lengths of patient stay. Dissatisfaction of patients, readmissions as well as more adverse occurrences-all that which reduced the quality of care. One part of a healthcare professional is to relieve the suffering of a patient. However, complex interventions usually cause the patients to undergo suffering in the process of restoring their health. By adopting the two strategies: increasing labor efficiencies and attracting and retaining good staff is essential in achieving positive patient outcomes. Adequate staffing is an ambiguous concept which has forced healthcare facilities to drift into uncomfortable positions. Finally, ethical issues in healthcare have lasting effects on the industry’s endeavors and such, healthcare professionals need to try and avoid having their staff being in positions of ethical dilemmas.