Finding a Balance between Lowering Stress Levels of Staff and Increasing the Quality of Patient Care

Work related stress has an impact on the health and wellbeing of nurse’s. It is a response to work demands, and pressure that may not match the employee’s knowledge, skills or ability and challenge their ability to cope (World Health Organisation (WHO), 2017). Stress within the workforce is regarded

Prior to the hourly rounding implementation, all the clinical staff (staff involved in patient care) will attend an hour workshop, which will cover the advantages and significance of hourly rounding to patient safety, reduction of falls, increase patient satisfaction, improved health outcomes, and financial impact to the organization. A video on how to do the hourly rounding properly and what behavior to avoid will be shown. After the workshop, the staff will do return demonstration, playing the role of the staff, while being checked off to ensure that the expectations during hourly rounding are met. This includes how to properly introduce oneself to the patients, informing the patients that the staff will be rounding every hour till 2200 then every two hours till 0600, to address their pain, possession, position, and potty needs. By performing return demonstrations, the validators (nurse managers, educators) will be able to ascertain that the staff understood and will

Rounding allows nurses to gather information in a structured way. It’s proactive, not reactive like call light responses. It’s a great way to get a handle on patient problems before they occur. It’s all about providing the best patient-driven health care… The great thing about hourly rounding is that it doesn’t benefit only the patients. (¶ 4).

For some nurses, mandatory overtime can be an advantage due to financial instability but mostly mandatory overtime can cause fatigue, burnout, injuries, errors, inadequate sleep and deficits in performance. According to research working long hours which consists more than 40 hours a week or over 12 hours a day leads to an increased medication errors and patient mortality. The probability of making medication errors increases tremendously when nurses work longer than 12.5 hours a day. During surveys regarding reasons of overtime, 60 % of nurses stated that overtime was obligatory as part of their job, 29 % of nurses stated that they volunteered and 41% of nurses stated that they were “on call hours” (Bae, 2012)

Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.

Hourly rounding also known as intentional rounding or comfort rounding is an initiative that hospitals nationwide are beginning to implement. Hourly rounding should be purposeful. “Hourly rounding is a systematic proactive nurse-driven evidence based intervention to anticipate and address needs in hospitalized patients” (Deitrick, Baker, Paxton, Flores, & Swavely, 2012, p.13). “Purposeful nurse rounds encompass a practice where nurses attend to and document scheduled patient reviews at pre-determined and regular intervals (hourly or second hourly)” (Lyons, Biunero, & Lamont, 2015, p.31).

Within the recent years, hospitals and medical facilities have been experiencing nursing shortages that necessitate more nurses to be present to compensate for the care needed to be given. This requires nurses to be dealt with imperative extended work hours along with their normal shifts with no denial or excuse accepted. Working extra hours are accompanied with negative effects that have an impact on the nurse, coworkers, and patients. A major concern that occurs with overtime is that nurses become fatigued or burnout. Fatigue that is experienced is a result of sleep deprivation from working overtime that is associated with arduousness neurobehavioral functioning

Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in

Nurse rounding is important to hospital-based practice because it directly impacts patient satisfaction (Blakley, Kroth, & Gregson, 2011). It serves as a method to improve quality of care by allowing nurses to routinely visit their patients and provide for any needs while also anticipating any safety concerns. Patients’ overall perceptions of hospital experiences are heavily dependent on how successful nurses are in satisfying the basic needs (Blakley et al., 2011). Rounding permits nurse-patient interaction and communication periodically, allowing observation and exchange of relevant information and also implementation of proper interventions. Nurses must practice rounding competently

Limited attention has been paid to the hours worked by nurses, or the effects of these hours on patient safety (Rogers, 2008). Even though most nurses favor 12- hour shifts and overtime, it is associated with difficulties staying awake during times of duty, reduced sleep times, and triple the risk of making an error (Rogers, 2008). The most significant risk of making an error occurred when nurses were scheduled to work 12.5 hours or more.

The provision of appropriate nurse staffing is necessary to reach safe, quality outcomes; it is achieved by dynamic, multifaceted decision-making processes that must take into account a wide range of variables” There are two different types of nursing one being centralized and the other is decentralized. Centralized staffing occurs when one department must staff all units, and decentralized is when unit leaders such as managers must regulate the level of staffing that must occur before and during a shift based on different circumstances. All hospitals do not use the same staffing method. Some might use budget based where nursing staff is billed per nursing hours per patient day, while other uses the nurse-patient ratio where the number of nurse per patient controls the staffing level, and lastly some hospitals go by the patient acuity where patient characteristics are used to regulate a shifts staffing needs (What Every Nurse Should Know about Staffing, 2014). No one method is better than the other and most hospitals seem to use all three, but one should question how accurately these methods are accomplished when there are so many nurses complaining about the hours they work and the number of patients that they are responsible for, and so many patients suffering from the lack care they are receiving

Nurses are continuously exposed to high levels of stress and anxiety that, over time, can affect job performance. In the article “The impact of job stress on the job performance of nurses” the main focus is hospitals in Irbid, but can also be related to hospitals in North Carolina. The study was conducted by Dr. Fatima lahcen and Yachou Ait Yassine in August of 2016. To make a more accurate reading on stress, related to age, gender, and education, they decided to conduct an educational survey. Many of the individuals who took the survey were nurses, and was notably a moderate level of stress leading to fairly high levels of job

To provide high-quality care for the patient it is essential for the nursing staff to have enough time for recovery from long hours of demanding work. Eight-hour shifts for hospital nurses have become a standard of the past. Nowadays, 12-hour shifts for three days a week have become typical in most hospitals as recommended by the Institute of Medicine (IOM) (Stimpfel, Sloane & Aiken, 2012). The length of the shifts and the working days; however, are often unpredictable due to increased demand for patient care and high census episodes. Nursing shortages, along with a weak economy, have left hospital nurses with no choice, then to work extended hours and overtime. Long hour shifts, as well as mandatory overtime, has become an increasing

It is a common scenario to hear nurses complain that they are burdened with the heavy patient workload and they are at risk for lowering the professional quality of life. This might be due to various factors like under-staffing, increase in the demand for nurses as the population ages, inadequate supply of available nurses, intentional lowering of staff on roll to reduce costs, and more needs due to shorter hospital stays. Nurse patient ratio should be kept at a manageable level in the best act to practice safe. Professional fatigue for the nurses and the resulting errors can only be reduced by keeping the nurse patient ratio in the recommended range.

Hourly rounding is a continuing challenge for hospitals across the United States. What’s effective about this method is that it has brought some positive changes to some Health care facilities. There are three factors that have been constantly tested to improve patient care. These factors are: 1) fall rates 2) call light usage and 3) overall patient satisfaction.