References
American Hospital Association. (2008). Report on the economic crisis: Initial impact on hospitals. Retrieved from http://aha.org
Centers for Medicare and Introduction Staffing shortfalls in the medical community have been noted since the turn of the century (Coss, 2009). There are not enough professionals being adequately trained to handle the increased demand for complex health care (Stock, McDermott, & McDermott, 2014). Many hospitals experience nursing shortfalls due to this shortage. However, some shortfalls result from the hospital 's inability to financially maintain adequate staffing. Hospital management is forced to make difficult operating decisions as they continue to recover from the financial crisis of 2008 (American Hospital Association, 2008).
Statement of the Problem Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections, according to research funded by the Agency for Healthcare Research and Quality (Stanton, 2004). The number of qualified nurses continues to diminish as nurses leave the field due to burnout (Carayon & Gurses, 2008). Nurses who work in understaffed hospitals report a greater workload and greater instances of work-related stress than do nurses in well-staffed hospitals (Carayon & Gurses, 2008). These issues stem from dysfunctions in healthcare management, prompting a focus on the considerations made by a hospital 's Chief
Over the last decades both public and private hospitals have been experiencing severe financial situations (Everhart, Neff, Al-Amin, Nogle, & Weech-Maldonado, 2013). The financial shortage is associated with delay or even lack of governmental sponsorship and competition from their rivals. Enacting the policy will mount financial pressure on these hospitals that are on cost-cutting strategies. The salaries and wages of nurses are dominating the costs of operation in the hospitals and therefore adding more staff to correct the understaffing will be like creating another problem (Goddard, 2003). Contrary, Empirical studies prove that adequate nurse staffing produces better outcomes for both the staffs and the patients (Donaldson & Shapiro, 2010). These do not mean that the financial performance of the health centers will be at stake. Quality is associated with profitability. Understaffing leads to increased workloads, fatigue and job dissatisfaction. These situations that can be corrected on the implementation of proper staffing policies (Everhart, Neff, Al-Amin, Nogle, & Weech-Maldonado, 2013). The policy aims at offering quality service, reasonable patient-doctor ratios, reducing high mortality rates, improving the health of patients through proper examination and disease diagnosis among other
Nurse staffing and how it relates to the quality of patient care has been an important issue in the field of nursing for quite some time. This topic has been particularly popular recently due to the fact that there is an increasing age among those who make up the Baby Boomer era in the United States. There will be a greater need for nurse staffing to increase to help accommodate the higher demand of care. Although nursing is “the top occupation in terms of job growth,” there are still nursing shortages among various hospitals across America today. The shortage in nurses heavily weighs on the overall quality of care that each individual patient receives during their hospital stay (Rosseter, 2014).
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.
Understaffing of nursing services is one of the prime issues affecting the profession presently. Hospital operations and patient outcomes are dependent on the number of nurses available to deliver the required outstanding care to diverse critical ill patients. Nursing shortage in various healthcare facilities leads to work overload thus reduces the productivity of the available nurses. According to Glette, Aase & Wiig (2017), patient safety is compromised by understaffing. Their research established that there is a relationship between the shortage of nurses in a hospital and the adverse events that occur. The adverse events such as the incidence of nosocomial infections cause a direct impact on the patient outcomes.
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.
The contrast between an adequately staffed ward and one with a low nursing staffing level is tangible. Staff nurses and patients have expressed how inadequate staffing levels affect them and there is a substantial amount of evidence-based research showing the negative effects of low nursing staffing levels on patient and nursing outcomes. Nursing resource allocation and reallocation of staff nurses is a time consuming and challenging task for nurse leaders, who must ensure safe staffing levels are upheld (Ball et al. 2014). With an increasing constraint on health expenditure, nursing staffing levels in hospitals has become a main target for financial limits and spending reductions. To the extent of which the nursing profession has been called a ‘soft target’, for it is easier to reduce nursing staffing level, as opposed to other means of cutting costs, such as improving efficiency (Aiken et al. 2014b).
In recent years, the healthcare industry has seen a significant decline in the quality of patient care it provides. This has been the result of reduced staffing levels, overworked nurses, and an extremely high nurse to patient ratio. The importance of nurse staffing in hospital settings is an issue of great controversy. Too much staff results in costs that are too great for the facility to bear, but too little staffing results in patient care that is greatly hindered. Moreover, the shaky economy has led to widespread budget cuts; this, combined with the financial pressures associated with Medicare and private insurance companies have forced facilities to make due with fewer
The current and growing shortage of nurses is posing a real threat to the ability of hospitals, long-term care facilities, and others to provide timely access to quality care. Nurse staffing shortages and nurse turn-over contributes to the growing reduction in the number of staffed patient beds available for services, increasing costs, and rising concerns about the quality of care. Health care organizations highly depend on nurse managers and leaders to reverse this trend. This paper discusses the reasons for nursing shortage and turn-over, different approaches to solve this issue, and my personal philosophy about this issue.
It is likely that most people have heard about the nursing shortage for years now, and perhaps they believe it’s been fixed. However, the nursing profession is experiencing a reoccurring deficiency. According to Brian Hansen, (2002), there was a nation wide shortage in 2001 of 126,000 full-time registered nurses, but the shortage will surge to 808,000 by 2020 if something isn't done. This pattern is a persisting cycle of high vacancies followed by layoffs and a high over supply of registered nurses. Various factors contribute to the lack of nurses within the health care facilities, but today’s shortages are a little different. Many feel that this scarcity is severe and long-drawn-out. The four major issues contributing to
Nurses are crucial in providing quality care in the health care industry. It is imperative to maintain the proper staffing ratio to ensure that nurses can maintain high quality care for their patients. Studies have shown that the increasing workload of nurses can be linked to increased patient deaths, medical errors, hospital-acquired infections, longer hospital stays, and many other complications. (National Nurses United n.d. ) Leaders and managers play a vital role in developing
The broad research problem leading to this study is the belief that nursing shortage in facilities leads to patient safety issues. The review of available literature on this topic shows strong evidence that lower nurse staffing levels in hospitals are associated with worse patient outcomes. Some of these outcomes include very high patient to nurse ratio, fatigue for nurses leading to costly medical mistakes, social environment, nursing staff attrition from the most affected facilities. The study specifically attempts to find a way to understand how nurse
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.
Though they are not entirely comprehensive tools, a great deal can be learned about a hospital or other healthcare organization for-profit or not-for-profit from an examination of their annual financial documents (Finkler & Ward, 2006). The balance sheet and statement of revenue and expense can both yield valuable clues even in the absence of other evidence about changes that might be occurring in the organization, a definition of the type and degree of certain problems that it might be facing, and potential opportunities for improvement in performance that might exist (Finkler & Ward, 2006). Comparing two or more years' worth of financial information yields even more valuable insights, tracking movement in the hospital or other organization's ability to finance its activities and thus continue providing services at the same level, quantity, and scope as current operation.
A continuous concern that continues to present itself within the healthcare environment is adequate staffing on nursing units. Most hospital organizations try their very best to accommodate staffing needs, though many units remain understaffed for an unspecified amount of time. Inadequate staffing can negatively affect patient outcomes, lead to nurse burnout, and decrease patient satisfaction scores. Combating this issue will require a great deal of effort, as many geographical face nursing shortages when seeking new graduates and qualified candidates. Employees may begin to feel that they are unable to pursue personal goals within a healthcare organization, due to inability to transfer as a result of staffing shortages. This often results in nursing seeking employment or career advancement outside of the organization or geographical area, which further intensifies ramification associated with inadequate staffing.
Alongside these professional and academic changes, the financial systems that the entire operation is based on had to evolve as well. Initially, hospitals in the US were voluntary and supported mostly by wealthy donors and some paying patients. These hospitals were not intended to profit or show financial solvency beyond daily operation. This posed a significant lack of consistency in providing care since the most of the governing body consisted of affluent individuals. (book)