Why Do Nurses Understake Or Malpractice

Pamela F. Cipriano, President of American Nurses Association was in disbelief to see how she has tried to enforce the Nightingale pledge of keeping patients free from harm was failed because medical errors are the third leading cause of death in the United States. As of now ANA has conducted yearlong campaign named “Safety 360 It Starts with You” in order to reduce and take measurable advances to protect the welfare of nurses and workers. It is one of campaign that the ANA comes with that is in support to both the nurses and patients. However, in the real-world nurses are stress and fatigue due to patient ratio. In my workplace, which is a state hospital, they have full time nurses on call where nurses work more than 70 hours a week. The nurses

Extensive research has shown that there is a correlation between staffing and patient ratio and patient outcomes. Better outcomes particularly are shown with lower patient to nurse ratio. However staffing issues remain an ongoing concern which greatly impacts the safety of the nurse and their patients, and also impacts cost of healthcare. Evidence shows that adequate staffing causes reduction in mortality, nurse burnout and job satisfaction, and reduction in medical errors.

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

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.’

For every additional patient added to a nurse's workload, a hospital's death rate has been shown to increase by 7 percent, meaning that if a nurse is responsible for four patients and then has her care load doubled, there is a 31 percent increase in the patient death rate for the hospital. The percent increase is even higher for critical need patients. As many as 98,000 patients die each year from medical errors and ensuring high nurse-to-patient ratios is an essential component of reducing that rate.

Several studies have shown that patients get well faster and safer when they receive more nursing care. Even more importantly according to Linda Aiken study (2003), mortality rates and staffing ratios are closely tied. Each additional patient per RN after four patients, chances of dying in the hospital is increased by 7%.Patient on a surgical unit with patient –RN ratio of 8:1 were 31% more likely to die within 30days than those on surgical units with ratios of 4:1.Studies have shown that more infections like UTI, pneumonia, shock or cardiac arrest increases when patients receive fewer hours of nursing care. Medication errors and unsafe hand washing techniques were found more in increased patient workloads. Unsafe staffing gave more job dissatisfaction, job burnout and more nurses quit or drove nurses away from nursing. This increased mandatory overtime and increased nurse shortage. According to survey of California state

Significance: Because nursing is the largest health care profession and nurses provide most of the patient care, and as an acute nurse, I can relate to how unsafe nurse staffing/low nurse-to-patient ratios can have negative impact on patient satisfaction and outcome, can lead to medical and/or medication errors and nurse burnout. It can also bring about anxiety and frustration, which can also clouds the nurses’ critical thinking. Most patients might not know the work load on a particular nurse and can assume that her nurse is just not efficient. Doctors also can become very impatient with their nurses because orders are not being followed through that can delay treatments to their patients. There is also delays in attending to call lights resulting in very unhappy patients who needed help.

The purpose of this paper is to illustrate and demonstrate the significance of lowering the nurse to patient ratio, while implementing quality health improvements. Today’s complex healthcare system faces a number of difficulties that affect the quality of patient care and safety. Current nurse to patient ratios are of increasing focus in today’s healthcare system. Nursing staffing ratios have an effect on numerous areas within nursing; however, one of the most profound is the effect on the quality of care delivered to the patients. For example, medication errors and prevention are important in all aspects of care. Appropriate time is needed to administer medications; however, with overworked nurses and overextended patients loads, nurses are pressed for time. Nurses have the opportunity and responsibility to make sure that their patients obtain quality of care through interventions that keep patient safety a priority. Strategies should include keeping nursing staffed at adequate levels and appropriate to the type of patient care. Furthermore, the patient’s acuity and the nurse’s assignment should be taken into consideration.

As a result, overtime can compromise patients ' health or safety. Medical residents cited fatigue as a cause for their serious mistakes in four out of 10 cases (Boodman 2001), and two studies linked infection outbreaks at hospitals to overtime work (Arnow et al. 1982; and Russell et al. 1983). Indeed, the California Nurses Association reports that more nurses are refusing to work in hospitals with unsafe conditions, in which they include being forced to work unplanned overtime. The American Nurses Association (ANA), in a national survey of 7,300 of its members, found, disturbingly, that 56% of nurses believe that the time they have available for care for each patient has decreased, and 75% feel that the quality of patient care at their own facility has decreased in the last two years. The cited inadequate staffing as the chief reason.

According to The Journal of the Medication Association (2002), Hospitals, which routinely staff with 1:8 nurses to patient ratios, experience five additional deaths per 1,000 patients than those with 1:4 nurse to patient ratio. Safe nurse staffing ratios has been a significant issue that, registered nurse professionals have been struggling to overcome for many years. In the randomized research study, “Nurse Staffing Levels and The Quality Care in Hospitals”, by Needleman, J, Buerhaus, P, Maureen, S, and Zelevinsky, K, administrative data was collected from hospitals based in 11 states, to determine the correlation between the amount of care provided by nurses, safe staffing levels, and adverse patient outcomes. According to this study, “Among

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.

Mandating safe staffing levels for registered nurses in acute care settings has been an important topic of discussion for many years. As the demand for registered nurses continues to rise, so does the clinical demands on the nurses currently working. If there are no specific policies in place that mandate safe and appropriate nurse-to-patient ratios for all acute care facilities, registered nurses (RNs) may be required to take on even more patients than the already high numbers currently given to many of them. Inadequate RN staffing has the potential to cause increases in adverse patient events (American Nurses Association (ANA), The registered nurse safe staffing act, 2015) as well as an increase in nurse injury (Musick, Trotto, & Morrison,

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)

Current healthcare practices today have largely been influenced by the Institute of Medicine (IOM) 1999 report, To Err is Human: Building a Safer Healthcare System. This report delineated many weaknesses in the practice of medicine regarding the safety of patients within the healthcare industry. This report has increased public awareness regarding the need for transparency around reporting serious safety events as well as the need to implement best practices in an effort to increase patient safety. Additionally, Medicare initiatives support the need for increased quality of care as hospitals will suffer financial loss due to declining reimbursement for patient. Patient satisfaction and safety are imperative in order for care to be provided. One effort which can help support improvements in patient safety and quality of care is through hourly or intentional rounding on patients. This rounding practice amplifies the nurse-patient relationship, provides continuity of care, increased safety, and service excellence. Intentional rounding or rounding with a purpose, can be a success, as long as nursing staff understand the full implications and the potential for positive outcomes, and take complete ownership of the rounding initiative. Leadership and nurses need to work collaboratively and be cognizant of each other’s role pertaining to the delivery of care regarding this practice. The purpose of this research is to depict the importance of hourly rounding as a

Staffing deficits pose a direct threat of manifesting negative outcomes associated with the delivery of patient care. Anything or anyone that compromises patient care should be eradicated immediately. This author believes that staffing deficits remain a consistent issue due to lack of solutions that actively address the issue. This author believes that inadequate staffing is a major concern due to the degree of harm it can impose on patients. Adverse events associated with