Nursing Care Issues Paper

Hello Students, my name is Teresa Damien MS, APRN-BC. I have been a registered nurse for over a decade and currently practice as a psychiatric mental health nurse practitioner at an academic institution clinically focused in addiction psychiatry. I have worked in multiple areas of nursing over my career prior to mental health that include medical-surgical nursing, respiratory nursing, hospice nursing, home care pedicatric nursing, and nursing education.

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 health care industry is experiencing a surge in the number of baby-boomers needing health care and increased demands on the physicians providing the care. This trend has made the role of Advanced practice providers more important (cite). It is imperative to understand the differences and similarities in the advanced practice provider roles as it pertains to healthcare. This paper will identify specialty nursing roles including advanced practice registered nurses (APRN). It will further compare and contrast the advanced practice nurse (APN) and physician assistant (PA) roles in practice.

Question 2: I provide almost all of the care for assigned patients throughout the shift but may not have the same patients from their admission to discharge

The debate to find the perfect balance of nurse to patient ratio continues between healthcare workers and legislators. According to an article in Modern Healthcare magazine, “Got enough nurses?” Nurse groups cite a Kentucky case to support push for staffing ratio laws,” nurses attending to a dozen or more patients at a time is “physically impossible” (Rice, 2015). Rice reports statements made by Gerard Brogan, lead nursing practice representative for the California Nurses Association, Pamela Cipriano, president of the American Nurses Association, American Organization of Nurse Executives, a subsidiary of the American Hospital Association, Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center in Nashville, Doctor Christine Cassel, CEO of the National Quality Forum, Bonnie Castillo, director of the Registered Nurse Response Network for National Nurses United union, Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, discussing research and other insights into the hardships of large nurse to patient ratios. As nurses continue to research and present data to contest the high patient to nurse ratios, hospitals push back with confronting data and research; both unable to reach an agreement.

Nursing, as the largest health care profession in the United States, plays a tremendous role in health promotion and delivery of care. From the 2.7 million employed registered nurses to the current Deputy Surgeon General of the United States, nursing infiltrates all aspects of healthcare (Bureau of Statistics, 2015). Therefore, as a profession, nursing must understand the intricacies of the Patient Protection and Affordable Care Act (ACA) and within its framework develop strategies to “advance nursing, health, and healthcare through education, clinical practice and research,” (Young et al, 2017). This paper aims to review portions of the ACA as it pertains to nursing, and offer an example of nurse practitioner innovation in practice.

Nurses find themselves in the middle of a complex health care system between the financial side and patient safety. A professional nurse’s goal is to provide safe, quality, patient care. However, nurses often fail to meet this goal due to the variability in patient acuity, the unpredictable workload of nurses, and institutional budget constraints (ANA, 2014). According to the American Nurses Association (2014) research shows that lower staffing levels of registered nurses correlate with poor patient outcomes, as well as negative nurse outcomes, such as physical injury and ‘burnout.’

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Working with the available staff increases the nurses’ workload and the risk for patients’ negative outcomes. Heavy nursing workload adversely affects patient safety and negatively affects nursing job satisfaction (Carayon & Gurses, 2008, p. 1). Furthermore, a study on the hospital nurse shortage and the California legislation about minimum hospital patient-to-nurse ratios concluded that the nurse staffing levels affect patients’ outcomes detrimentally; for each additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission and a 7% increase in the odds of failure-to-rescue. In addition, this study concluded that 23% of the nurses were associated with burnout and a 15% increase in job dissatisfaction (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002, p.

I can remember serving in the Air Force as a nurse and working with the chief of nursing. During my training period, things just seemed so difficult and hard for me to grasp under such a stressful environment. The chief of medical was very detail oriented and she would always pushed us to think outside of the box. We would go through different mock code scenarios as if we were out in the battlefield for two weeks. If we did not respond to the level of her expectations, she would make us redo the mock code scenario over again. There were many days in which we felt frustrated, giving up and crying. In the end, we realized that the chief of nursing was just trying to build our character, instill confidence and prepare us for future of being in a war zone.

The purpose of this paper is to conduct an in depth exploration of the nursing care considerations of patients in a specific clinical area. Through the synthesis of prior knowledge, clinical experiences and skills, evidence based best practices, and care of patients a comprehensive care and teaching plan will be composed. Integration of critical thinking and clinical reasoning skills, combined with evidence-based research will provide confirmation of nursing process comprehension. The inclusion of reviewed literature will further support knowledge and understanding.

The demands on nurses are greater than ever do to the shortage. Nurses often find themselves working longer hours under intense and stressful conditions. The shortage of nurses creates a higher nurse to patient ratio. These factors often have a number of negative consequences that range from overwhelming, exhaustions, injury and job dissatisfaction. According to the American Nurses Association, nurses working in stressful environments are more prone to making mistakes and medical errors (ANA). Studies show that when nurses are forced to work with high nurse-to-patient ratios, patient outcomes are negatively impacted. Death rates, infection rates, and readmission rates are all increased when the ratio is high. When nurses have fewer patients, they can take better care of them.

According to the Merriam-Webster dictionary “professionalism” is “skill, good judgment, and polite behavior that is expected from a person who it trained to do a job well” or “conduct, aims, or qualities that characterize or mark a profession or a professional person” (Merriam-Webster, 2015). Applying this to nursing, how do you see “skill, good judgment, and polite behavior”, or mark the “conduct, aims, or qualities” that make a nurse a professional (Merriam-Webster, 2015)? Dr. Tim Wilkinson, “Associate Dean of Medical Education at the University of Otago” sought to define “professionalism” with two of his colleagues (Collier, 2012). He pinpointed five categories including; “adherence to ethical practice principles, effective interactions

Reflecting on the time spent working in the Neuroscience Department at Sinai Hospital, I am grateful that I could be a part of this program. I am proud to say that I have evolved from the student nurse that applied for this position three months back. Working on the unit has given me the confidence needed to propel me into the next phase of the nursing program. As I prepare to go back to school, I will utilize the skills that I have learned to provide quality and safety to my patients.

The nursing profession has been around for a very long time. Through many changes and reforms, it has drastically evolved into the nursing profession we have today. Nurses have an important role within the healthcare industry in the treatment and medical care of the sick. These trusted healthcare professionals continue to make up the largest majority of the healthcare field, as well as the fastest growing occupation. Nursing is a job that allows people to not only care for the sick but also to experience, learn and further their interest in the human body. This course has definitely provided me an insight to the roots of the profession I would like to pursue. I think it is important to know the history of nursing to understand fully on the problems that are affecting the profession. I believe that we cannot effectively address important issues without a foundation of historical knowledge. In other words, by examining the nursing history, I will be able to appreciate my important role as a nurse in the healthcare system. The topics I will be including in my reflection are the works of Florence Nightingale, the affects of World War II, the challenges of Filipinos aspiring to be nurses, and excerpts in Chapter 10 of “A History of American Nursing.”