WK3 RESPONSES 6053

Jonise Flynn

Competing Healthcare Needs and Policymaking  

The goal of many healthcare organizations and legislations that frame healthcare is based on the need to improve healthcare delivery. Legislations such as the Affordable Care Act (ACA) of 2010, seek to not only improve access to care, but warrant the implementation of care that is cost-efficient, yet safe (Blumenthal et al., 2015). Through ACA, healthcare entities received financial incentives to deliver care that met healthcare goals of reduced readmissions and lowered hospital-acquired morbidities (Blumenthal et al., 2015). Policies to improve healthcare delivery also penalized healthcare facilities for inadequately meeting healthcare standards, leading to poor patient outcomes and higher death rates (Blumenthal et al., 2015). Competing needs in the workplace, such as available workforce, resources, and patients, have a profound effect on the quality and cost of healthcare, which, in turn, guide healthcare policies such as ACA. Patient care is negatively impacted when the nursing workforce and resources availability competes with the need for reduced organizational costs (Kelley & Porr, 2018). Kelley and Porr (2018) state that organizations strive to use the least amount of resources to effectively deliver care, resulting in lack of patient centered care. Understaffing of nursing staff and unmet demands of inpatient facilities create poor patient outcomes and higher healthcare expenditures. Such healthcare effects bring the need for reform to the healthcare forefront, and reformative measures are inevitably addressed through innovative healthcare policies.   

Workforce Availability, Cost-Efficient Care Demands, and Nursing Shortages 

Nursing shortages is a workplace stressor that affects nursing professionals on a global basis. Kortbeek et al. (2015) ascertain that nursing shortages can significantly affect patient care quality and should be addressed by inpatient nursing management. Many healthcare facilities seek to leverage the number of available nurses and nursing workload demands. With nursing staff being a significant portion of organizational budgets (Kortbeek et al., 2015), finding a balance between the number of nurses to cost-efficiently care for patients and the inpatient demands can be challenging. Many times, nursing is understaffed to save facility costs, leaving more work demands on fewer nurses. The deficient nursing workforce directly affects nursing workloads, resulting in an increased number of patients per nurse. I have seen patient workloads as high as one nurse for eight patients. Due to the variability of admissions, discharges, and available staff, optimizing patient care loads can be difficult, leaving short-staffed units with overworked, burned out nurses (Kortbeek et al., 2015). The drive to contain costs in organizations has mantled the need for care that is patient-focused, leading to patient care that is more business driven (Kelley & Porr, 2018). 

Impact of Competing Healthcare Needs and Policies to Address the Issue  

When nursing workforce supply is lower than the care demands, nurse-patient ratios are increased, leading to stressful, unsafe work environments. Competing needs of available nursing staff and cost-efficient care lead to elevated nurse-patient ratios. Both Driscoll at al. (2018) and Kortbeek et al. (2015) recognize that mortality rates, patient satisfaction, and safe healthcare practices are significantly impacted by the nurse to patient ratios. A study by Driscoll et al. (2018) found that there was a fourteen percent decrease in death rates for every extra nurse to care for patients. Areas such as California and Australia have already set forth policies that specify the number of patients that healthcare facilities can safely assign to nurses (Driscoll et al., 2018). Other geographical areas acknowledge that issues exist with nurse-patient ratios, yet only make recommendations rather than laws that prohibit unsafe nurse-patient ratios (Driscoll et al., 2018). Policymakers should understand the correlation between nursing shortages, nurse-patient ratios, and mortality rates, to effectively create policies that lower the nurse-patient ratio and encourage safe, efficient care. Policies should not only consider that care is negatively influenced by unethical nurse-patient ratios, but the fact that nurses are at risk for health disparities as well.  

References  

Blumenthal, D., Abrams, M., & Nuzum, R. (2015). The affordable care act at 5 years. NEJM: The New England Journal of Medicine, 372, 2451-2458. https://doi.org/10.1056/NEJMhpr1503614  

Kelley, P., & Porr, C. (2018). Ethical nursing care versus cost containment: consideration to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23 (1), Manuscript 6. https://doi.org/10.3912/OJIN.Vol23No01Man06 

Kortbeek, N., Braaksma, A., Burger, C. A., Bakker, P. J., & Boucherie, R. J. (2015). Flexible nurse staffing based on hourly bed census predictions. International Journal of Production Economics, 161, 167-180. https://doi.org/10.1016/j.ijpe.2014.12.007 

Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6-22. https://doi.org/10.1177/1474515117721561 

Henrietta Mosoke RE: Discussion - Week 3 Main PostCOLLAPSE

Organizational Policies and Practices to Support Healthcare Issues

Nursing Shortage and Quality Patient care

 According to the American Association of College of Nurses, AACN (2019), the shortage of nurses had been debated more than a decade ago. Nursing shortage and the need to provide effective quality care can be very parallel thereby making it difficult if not impossible for organizations to develop policies. Nurses are very instrumental in providing much-needed care for patients, but when the nurse-patient ratio is very high, it becomes difficult for nurses to function in the way they know best. Therefore competing needs arise which impact nursing shortage such as the need to provide quality care to patients and the whole medical service providing care in a timely and efficient manner. So, for an organization to make sure the patient's needs are met, it also has to make sure there is enough manpower to provide such needs, hence the conflict. The nursing shortage is directly proportional to the care provided.

Financial Wellbeing of an organization and Nursing Shortage

            Most organizations worry about their profit margins irrespective of the burden that is placed on nurses. According to the article by Kely & Porr (2018), "Raising awareness of the disconnect that exists between organizational agendas and the ethical obligation of nurses to provide a certain standard of care may be the first step to improve understanding". In a bid to address the nursing shortage that most organizations are faced with, there is a need to either have a float poll of nurses to fill the voids of most units or for agency nurses and Weekenders to supplement such shortages. Unfortunately, the rates of payment of such nurses are often higher than the regular nurses on the unit as agency or float poll nurses are not given any benefits such as health insurance. As a result, most organizations use such nurses as a last resort or in some cases do not, while the shortage of nurses persists. With one nurse too so many patients, the quality of care provided is bound to be poor.

Impacts of Nursing Shortage and Policy Implication

 Nursing shortage impacts nurses negatively. Most nurses suffer from burnout from working with so many patients than they can handle and sometimes with very high acuities. Nurses are also faced with the challenges of meeting certain organization targets like observing zero falls in 365 days. There are also issues of stress, fatigue, job dissatisfaction, anxiety, and depression as the thought of going back to work gets very overwhelming. According to Kelly & Tyson (2016), nurses are called upon to be mindful of themselves to be able to take care of the patients entrusted in their care. I believe organizations have to think of policies that can be used to recruit and retain nurses. For example, a hospital or healthcare organization can offer grants/scholarships to train a certain number of nurses each year and recruit such nurses after graduation. Also, instead of the aging population working until retirement, such personnel's services could be employed after they have served in the organization after a certain number of years. Such aging nurses could serve as mentors to the novice nurses so that their skills and experiences could be transferred. This could improve the retainment rate of nurses.

References

American Association of Colleges of Nursing (AACN). Fact sheet: Nursing shortage. (2019).

    https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage.

Kely, P., & Porr, C. (2018). Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice. Online Journal of Issues in Nursing, 23(1), 3.  Retrieved from https://doi-org.ezp.waldenulibrary.org/10.3912/OJIN.Vol23No01Man06

Kelly, M., & Tyson, M. (2016). Can mindfulness be an effective tool in reducing stress and burnout, while enhancing self-compassion and empathy in nursing? Mental Health Nursing, 36(6), 12–17. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=127544240&site=eds-live&scope=site

3 SOURCES FOR EACH DISCUSSION