The City Main Hospital Cochin,

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

In a different review of literature on staffing and patient outcomes, Heinz (2004) describes the relationships between staffing and mortality, length of stay, and complications of patients. At first the article paints a clear picture of the future of nursing as it starts to feel the shortage which is approaching due to aging of present nurses, lowered nursing school admissions, and other hospital issues including financial hardships. In looking at the impact of ratios on mortality there were five different studies identified that showed that the lower the ratio, the lower the risk of mortality of patients. A patient's length of stay was also influenced negatively with higher nurse-to-patient ratios and positively with specialized units and care from nurses. The impact of staffing on patient complications also showed that there was an inverse relationship between the two. Heinz concludes that the key to solving these problems in nursing and reducing negative patient outcomes is nursing recruitment and retention (Heinz, 2004).

For my seventh clinical shift at the Loma Linda Veterans Affairs Medical Center, my assigned preceptor Filipina Gumangan assigned me three patients on the 4NW unit. The unit where I precept is an intensive care step down unit. Filipina’s objective for giving me three patients this shift was to give me an opportunity to continue exercising my time management skills and to practice my reporting and charting skills, and wound care. This shift I was responsible for many clinical duties corresponding to the care of these patients. My patients this shift were Mr. B, a 72 year-old Vietnam War veteran newly diagnosed with colon cancer, Mr. S, a 65 year-old Vietnam War veteran in the hospital for complicated urinary tract infection, Mr. R, a 90 year-old Korean and Vietnam War veteran. Caring for these patients taught me more about the humanbecoming perspective of nursing and showed me about multidisciplinary coordination with peers, colleagues, and more.

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.

After working under these horrendous conditions, including lack of sleep, lack of electricity to keep the newest technology machines working, shut-down elevators and air conditioning, and an unsanitary working environment, the remaining staff members at Memorial did what they could. The reason and quantity of the medications that were found in patients’ bodies were unquestionably incorrect with the justification by Dr. Pou that she was simply trying to reduce their physical suffering and relieve their anxiety. In this case, Dr. Pou’s situation was considered malpractice, because people argued that there were other ways to help these patients. Rodney Scott, one of the last patients to leave the hospital stated, “How can you say euthanasia is better than evacuation?..If they had vital signs, then get ‘em out. Let God make that decision,” (Fink, 28). It is anticipated that nurses will experience challenging working conditions, including an environment of fear, and too much responsibilities or things to focus on. To prevent faster burnout and secondary trauma, nurses will need sufficient rest periods, emotional support especially from the hospital facilities and

Second in a discussion of power are the women associated with the patients. The supervisor at the hospital is associated with the patients by controlling who is employed to take care of the patients. Nurse Ratched and the supervisor served in the Army together as nurses. They are still very close and have a good relationship. Because of this relationship, Nurse Ratched’s employment is secured and others won’t stand up to her for fear of losing their own jobs. Harding states “In this hospital, the doctor doesn’t hold the power of hiring and firing. That power goes to the supervisor and the supervisor is a woman, a dear old friend of Miss Ratched’s” (61). The receptionist on the ward is Nurse Ratched’s neighbor

Nurse-to-patient ratios is not a new topic of debate for all of us who deliver care to patients every day. Only lately it has been a big issue that have caught the attention of many. Demands by the medical community for changes concerning staffing, asking for the government interventions in minimum staffing laws. Registered nurses have long acknowledged and continue to emphasize that staffing issues are an ongoing concern, one that influences the safety of both the patient and the nurse. (ANA, 2015) .nowadays hospitals are running for profit and the emphasis is not put on job burnout, stress, and endangerment of patients. Nursing shortages is a very pertinent problem, it will be optimum to have laws in place to help with the issue, however meanwhile leadership and management methods to the matter can help to mend the nursing situation and avoid many of the damaging effects of unfitting nurse-to-patient ratios.

While at Trinity the supervisor gonna call the Activities that were witness today activities that were witness today consistent off the strategies to take me off then off short fast and I have reload a patient karenconsistent off the strategies to take me off then off short fast and I have reload a patients the morning started off within a report give in for all members of securitythe morning started off within a report give in for all this thing is and nurses. Aaron this meeting the unit supervisor very gave with some encouragement to the staff. During this meeting she also informed the nursing staff the clients that were at risk such as the ones with that are prone to bad all sirs the ones are high risk at Falls the ones on isolation precautions. At this meeting was also a clinical nurse educator. On a normal daily basis she is responsible for doing quality rounds and making

The organizational ties that the Lees had to the hospital and its staff were characterized by miscommunication, condescension on part of many of the professionals, and mistrust on both sides. That the Lees distrusted the doctors in spite of their training offended the doctors, and the lack of assurance

With a shortage of nurses, the care and safety of patients may become compromised. The nurses themselves may be having feelings of dissatisfaction, overwhelm and distress. Nurses who may become overwhelmed with the high number of patients may become frustrated and burnt out. And inadequate staff of nurses may lead to a negative impact on the patient’s outcome. The quality of care the patients may receive in facilities with low staffing may be poor.

Meanwhile, elsewhere in Habersham County, Tom was feeling slightly nervous as he exited the staff lounge and entered the hustle and bustle of County Hospital’s ER to begin his first shift as an RN. The first few hours of his shift passed slowly as Tom mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. He realized that the attending physician, Dr. Greene, who was rather “old school” in general about how he interacted with nursing staff, wanted to start him out slowly. Tom knew, though, that the paramedics could bring in a trauma patient at any time.

Janice is responsible for the staffing of her unit (Palliative/Hospice) which has been named “The Light House” with 70 staff members working various shifts. As a manager of any unit within the Veterans Affairs Medical center, managers are expected to attend or review meetings minutes; meetings like the Nursing Council and Nurse Manager’s meetings as well as others committees. Managers are to hold staff meetings and communicate the minutes to all staff via email, or written form. Managers make sure all changes in policies, documentation, and other situations are reported to staff members. Managers are accountable for compliance of all regulatory standards, such as OSHA, CARF, and JC standards. Managers are to have an approved staffing plan, review expenditures affecting its cost, such as overtime, leave, and compensation time. Complete quarterly report/data, staffing effectiveness analysis reports, staffing updates, and FMLA information. As a manager, communication, performance improvement, staffing/recruitment, time and leave, safety/environment of care, controlled substances, adverse events/patient complaints, employee accidents/injuries, employee performance, performance appraisals and proficiencies, and staff development are all part of her duties.

FG, personal communication, March 1, 2015). The telemetry floor manager is responsible for all aspects of the unit’s operation and management. Mr. FG main job duty is to ensure the floor runs smoothly without any obstacles while providing the best possible patient care. Mr. FG currently has 78 employees (including charge nurses, staff educator, staff nurses, nurse aids, and secretaries) who report to him and he is directly responsible for. Mr. FG delegates some of the daily functions of the unit to the charge nurses, so that the unit runs smoothly while he focuses on other important his other duties. Mr. FG consider himself very professional and approach his staff member in a very professional manner and expects his staff maintaining the same professionalism with him and other team member. He also expect his staff to work as team and resolve any issue on the floor to the best of their ability in this manner. Even though his position as a manager on the floor to lead the team, but whenever there is a problem, he would like his every single member of his staff to be onboard to come up with a solution. Encourages everyone to talk to him whenever they feel the need and known for maintain an open door policy (Mr. FG, personal communication, March 1, 2015). Mr. FG reports directly to Chief Nursing Officer and the vice president of patient care services.

One of the greatest challenges in healthcare, as well as the biggest threat to patient safety, is staffing and the nurse to patient ratio on hospital floors. Studies have shown that low staffing levels lead to increased mortality rates in patients, as well as multiple other adverse effects including falls and pressure ulcers. These adverse effects are all preventable, but policies on staffing must be in place to ensure safety for staff and patients.

Neighborhood’s hospital is filled with patients who are ill with exacerbations of asthma and emphysema related to the poor air quality and smoke. The hospital’s emergency department calls for in-patient beds but there are no beds available. There are more patients needing beds than there are beds available. The emergency room nurses keep calling the floors to request beds, and none are available. The staff morale is low because they all feel the stress related to the pressure of early discharge for patients to make beds available. The nurses are kept busy with discharges and admissions, and are feeling overwhelmed and under-staffed. Hospital administration has decided to implement mandatory overtime adding to the stress of the staff.