Lack Of Regulatory Standards For Nurses

Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses (Jooste, 2013). The nurse manager has to explain to the management of the benefits of change in providing adequate staffing all the time. Adequate staffing helps staff retention. Staff retention saves a lot of money in terms of orienting new people to the unit. Safe staffing always helps in the reduction of falls, infection rates, pressure ulcers, decrease hospital stays and death. Flexible and creative scheduling is essential for retaining staff and promoting a positive work climate (Grohar-Murray & Langan, 2011). Adequate staffing with good staffing ratio will help nurses to concentrate on their patient care which may help in a reduction in medical errors and lawsuits to the hospital.

Research is one of the best ways to identify solutions to a problem. The problem being researched for this review is nurse burnout in the operating room and critical care areas. Nurse burnout negatively effects staff, patients and healthcare as a whole (Henderson, 2015).With the use of research plans to implement new guidelines and best practices can happen leading to being able to resolve the problem. With nurse burnout becoming more common leading to a nursing shortage and the amount of patients that will require care increasing, it will be very important to learn about and prevent nurse burnout.

Nursing to patient ratio can have a direct impact on patient safety. Studies have been done that show that these ratios impact patient outcomes and mortality rates when nurses are understaffed and are given a larger patient load than they can handle safely. Nursing education level has also shown to play a role in patient outcomes. Whether they are an unexperienced nurse or the patients are at a higher acuity and require more time for care, these larger ratios can be detrimental to the nursing quality of care that can be provided. These larger nurse to patient ratios can also play a part in nurse burnout leading to medical errors, negative patient outcomes, and higher health care costs in the future.

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

The term burnout, according to Catalano, is a continuing depletion of energy and strength combined with a loss of motivation and commitment after prolonged exposure to high occupational stress (2015). When a unit or facility is understaffed, not only do the nursing staff get burnt out, the patients also don’t receive the quality of care they deserve. Due to the increase in workload, nursing staff are more prone to making mistakes and medical errors and sometime times do not fellow facility policies. The nurse-patient ratio aspect sometimes gets overlooked at and that could lead to possible medication errors, lack of communication, falls, neglect, abuse and/or death may occur. Sometimes, it become so overwhelming people turn to leave the workforce all together. When nurses and CNA workload increase, they become frustrated and unhappy, and the desire to leave

Nurses work long hours and deal with high levels of stress during the workday which leads to nurse burnout. Nurse burnout is classified as physical and mental fatigue, which strongly affects the nurses emotions and motivation. (“Nursing Burnout”). Burnout is caused by various factors within the workplace, such as dealing with a hectic, fast-paced environment, caring for too many patients at one time, and working odd hours. When nurses deal with multiple patients per shift, high levels of responsibility, and their own personal problems, they can become exhausted and overwhelmed. Stress due to burnout can also affect the nurse’s mood in a negative way, causing the nurse to become impatient or irritable, which can oftentimes results in verbal or emotional abuse towards the

Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.

When nurses experience fatigue due to excessive overtime, effects that can occur are reduced decision making ability, reduced communication skills, increased forgetfulness, increased tendency of risk taking, reduced ability to handle stress on the job, decreased ability to do complex planning, and inability to recall details which can all danger patients wellbeing. Unfortunately even with all the

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.

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

Stressful work environments, long work hours and inadequate sleep all contribute to an increase in physical and mental exhaustion amongst nurses. Typically, people choose nursing as a career to help others and to make a difference in their lives, without realizing the number of duties this career demands. Nurses may suffer in silence when they are experiencing stress. The effects can impact safe and reliable care by decreasing job satisfaction, decreasing productivity, causing poor personal health, and compromising patient care. Many facilities would benefit from implementing evidence-based strategies to address nurse fatigue and burnout.

When a nurse has a heavy workload due to staff levels being inadequate it can lead to fatigue, slower thought process, slower reactions/responses, burnout, more errors due to oversite, and even to more of an increase in inadequate levels of staffing due to staff calling out of work. Levels of inadequate staffing can develop a vicious cycle that can ultimately progress into more harm to patients. It can lower satisfaction scores on the facility with dissatisfied patients; and inadvertently cause an increase of cost to the facility and insurances because of readmissions and an increase in more adverse, sentinel, and never events occurring. As a nurse becomes overworked and fatigued their thought process slows down and reactions become sluggish,

Hospitals nationwide are experiencing nurse shortage and increased workloads because of shorter hospital stays, fewer support resources and higher acuity in patients (Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D., 2004). Higher nurse workloads are directly associated with job burnout and job dissatisfaction which in turn causes more voluntary nurse turnover and relates to the increased nursing shortage. According to the Missouri Hospital Association the turnover rate of nurses has increased by fourteen percent in the last five years (Browning M., 2012). Nursing shortage is a real threat to the patient population. According to the Quality Health Outcomes Model by the American Academy of Nursing by Donabedian, effects of the healthcare interventions are characterized by the environment the staff works in (Vahey et al., 2004). Donabedian describes that quality metrics can be divided into three broad categories, structural, process, and clinical.

The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week. (Trossman, 2009). Working longer hours in a high stress area will always increase the error rate. Designating an adequate number of RN positions to ensure nurses work an appropriate schedule without overtime and that their workload allows for breaks. Managerial staff must work to develop specific policies about the length of work times based on the setting, patient and provider needs. Those policies should limit nurses from working more than 12.5 consecutive hours. Provide education for all care providers on the hazards and causes of fatigue. Continue to document unsafe staffing conditions and work with others to change the current work culture so that it recognizes the effects of fatigue on patient safety, as well as the nurse. (Berger, et al. 2006)

"decreased work performance, and ultimately, burnout. Nurses, en countering ongoing stress, are also more likely to eat poorly, smoke cigarettes,