Category: Nursing Shortage

Nursing Shortage’s Impact on Patient Safety

The topic of my choice that I have researched is the nursing shortage that I see during my clinical rotation. There are not always enough nurses on the floor for the acuity of patients that are admitted. The articles I reviewed give reasons on why the shortage exists, how it affects patient care, and how to help new RNs transition into the new role of Registered Nurse. The areas of improvement would be to hire more nursing faculty to teach qualified individuals to advance their training, not to burn out the nurse by giving them a high patient-to-nurse ratio and building the relationship of new nurses with their preceptors to be able to grow.

Patient safety and quality of care are being affected by the shortage of nurses. This is not a recent problem; it has been going on for many years; in fact, the legislation passed the Nurse Reinvestment Act in 2002, the Registered Nurse Safe Staffing Act of 2007 and 2010, and mandated nurse ratios at the State level to encourage nursing growth. The Registered Nurse Safe Staffing Act of 2010 states that it must be based on patient numbers and the intensity of care they need to take into account the level of education, training, and experience of the RNs providing care, ensure that RNs are not forced to work in units in which they are not trained and must consider other factors affecting the delivery of care, including unit geography and available technology.

Impact of Nurse Shortage on Quality and Safety

The bill would also protect RNs and others who may file a complaint about staffing, allows for the refusal of an assignment, and establish procedures for receiving and investigating complaints.” (The American Nurses Association, 2010, p. 2) (Martin, 2015, p. 4). The more nurses are available at the bedside, the greater patient satisfaction, improvement of quality of care, an increase in the morale of the nurses, greater job satisfaction, and greater retention rate for the employers there is. Staffing inadequacy questions the ethical principle of Beneficence and non-maleficence of the nurse by putting patient safety and how they care for a patient at risk. These two principles are the backbone of the way nurses practice. It is not only morally required but legally as well. Not being able to manage the workload and nurse fatigue can cause disregard for these principles.

A high nurse-to-patient ratio is directly responsible for nurses’ job-related burnout and job dissatisfaction. Adverse outcomes of a high nurse-patient ratio include pneumonia, cardiac arrest, shock, and UTI. Lower registered nurse-to-patient ratios are shown to reduce the mortality rate by more than 50%” (Sofer, 2005, p.20). (Martin, 2015, p. 4). A workload that is not realistic can result in chronic fatigue, poor sleep patterns, absenteeism, along with job dissatisfaction. What some organizations in California have done is they will have more RNs on staff and fewer unlicensed assistive personnel (UAPs). That, in turn, changes the RN’s duties, which would include housekeeping and transportation. The purpose is not to get rid of ancillary staff but to add more nurses that can care for patients.

Nursing Shortage: Educator Gap and New Nurse Transition

One of the reasons that there is a nursing shortage in the State of Texas is the lack of nursing educators. The average age of a nurse educator in the United States is 56.4. (Allen et al., 2017.) Retirement for educators is expected to increase. According to a report from the American Association of Colleges of Nursing, nursing schools turned away 68,938 qualified applicants from baccalaureate and graduate nursing programs in 2014 due to faculty shortage. In the same year, it was found that there were 1,236 faculty vacancies in baccalaureate and graduate nursing programs. In 2015, the National League of Nursing faculty census survey found there were 1,072 faculty vacancies in all types of nursing schools. (Allen et al., 2017.)

The transition between a Nursing Student and an RN is facilitated by structure and socialization. The structure consists of new Graduates having a safe environment where they are able to share experiences and ask for guidance. Socialization has a support system that includes a nurse educator, preceptor, and fellow staff. According to The University of New Mexico, 17.5% of newly licensed nurses only work for one year, while 43% of newly licensed nurses leave the hospital within three years of starting. (Blevin, 2018 p.199).

Encouragement is needed for new nurses; having a trusting relationship with the preceptor and nurse educator can promote communication if there is lateral violence in the workplace. It is important to have consistency with preceptors because new nurses can feel like they are being bounced around if there are multiple preceptors. Having this consistency helps the new nurse build their confidence and helps the preceptor provide feedback and opportunity to grow.

References:

1. Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing, 24(2), 4–6. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103796942&site=ehost- live&scope=site
2. Allen, P., Sportsman, S., Batchellar, J., Boswell, C., Cannon, S., Evans, M., Starlin, M., Valerio, J. (2017). THE NURSING FACULTY SHORTAGE: What Is Being Done in Texas? Texas Nursing, 91(3), 12–14. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125191895&site=ehost- live&scope=site
3. Blevins, S. (2018). From Nursing Student to Registered Nurse: The Challenge of Transition. MEDSURG Nursing, 27(3), 199–200. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=130397407&site=ehost- live&scope=sitec

Improving Nursing Retention

With the constant shortage of nurses acknowledged, the staffing and retention of nurses continue to be an area of concern. In many hospital settings, improving nursing retention is a challenge and leaves most facilities short-handed. The goal is to keep nurses in the organization. Most nurses work twelve-hour shifts or longer, and managers need to acknowledge their loyalty and investment in the organization. Recent reconstructions in organizations with strategic planning have made many nurses feel organizations lack poor management skills and are not loyal to permanent staff, and the unequal distribution of nursing staff has forced many nurses to leave positions within the first year of hire.

“The most commonly expressed reasons were: unsociable hours, dissatisfaction with salary, workload, poor image of the vocation, and lack of recognition in the workplace” (Nyssen et al., 2018, p. 239). Nurses devote themselves to staying within an organization related to benefits, and with many years of investment, they have seniority and they are in a comfort zone. “To this end, job satisfaction is comprised of various components, including; job conditions, communication, the nature of the work, organizational policies and procedures, remuneration and conditions, promotion /advancement opportunities, recognition/appreciation, security and supervision/relationships” (Halcomb et al., 2018, p. 1).

Strategies

Nurses no longer work hard for the money. I can validate that ten years ago, the unit I worked on was a hard-working, highly motivated group of team workers. This unit was my family away from home. During this period, the organization went through a reconstruction at the hospital, and the unit was closed until further notice. Nurses were moved to other units, and nurses lost their jobs. Nurses were devastated. Eventually, they no longer had weekend options, and this caused a Tsunami effect at the hospital. This forced nurses to seek employment in other surrounding hospitals.

The devastation caused mixed emotions, but the organization brought back only three positions for the weekend option. So many nurses left, and with few weekend option positions went to people who had been there the longest mostly. I was a misfit on another unit, and the staff resented me. I cried for months because I lost a family of co-workers. “Other factors identified to negatively impact job satisfaction included; a lack of recognition, poor role clarity, and poor organizational communication” (Halcomb et al., 2018, p. 11).

The organization began hiring travel nurses, but at what cost? Many nurses felt the organization was not dedicated to permanent staff. Travel nurses had more privileges than permanent staff, including no-call days, and travel nurses could make their own schedules. This resulted in low morale in units. On some days working during the week, only one nurse was the only permanent staff. “As hospitals move away from employing staffs composed of core RNs and toward employing higher shares of contract RNs, they have fewer patients who are highly satisfied” (Hockenberry & Becker, 2016, p. 908). Nurses function at many levels. However, the most important aspect of effective nursing and to decrease nurses leaving an organization is to build relations based on teamwork. “Good team functioning is associated with improved patient outcomes, heightened staff satisfaction, and reduced burnout (Miller et al., 2018, p. 1).

“With a historical background of nursing available to us, we can look back and learn from the past, those practices that did not help nurses to function effectively and improve upon them” (Samuel & Edward, 2016, p. 14). Nurses find it difficult to manage higher patient acuity, and nurses are burnout with the fast-paced demands of patient care along with short-staffing. Organizations should base patient care on acuity, not based on the number of patients, for strategic planning. “In order for optimal patient outcomes to be realized, nurses must be able to deliver the safe, quality care that patients deserve” (Chovanak, 2017, p. 6). This decreases nursing burnout and allows nurses to deliver high-quality patient care and gain independence and trust in their capabilities to stay committed to organizations.

In conclusion, the goal of every hospital is to develop and retain a nursing team dedicated to high-quality patient care. Currently, nurse retention and recruitment are priority issues in every health organization. The fundamental goal is to teach teamwork, so nurse leaders can work together efficiently to retain new nurses and provide excellent patient care as a team. Effective leadership in hospital units directly affects the satisfaction of nursing staff, and employees are interested in executives who can guide and manage the staff in a positive and encouraging way. (Krepia, Katsaragakis , Kaitelidou, & Prezerakos, 2018, p. 192). There are pros and cons to each side; however, nursing is a profession with many specialties of care, and it is the organization and nurses who help guide the recruitment of nurses.

References:

1. Chovanak, L. (2017). EDITOR’S NOTES. Why Reducing Nurse Fatigue Has an Economic Benefit to Hospitals. Ohio Nurses Review, 92(6), 4-7. Retrieved from Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=129053205&site=eds-live&scope=site
2. Halcomb, E., Smyth , E., & McInnes, S. (2018, August 1). Job satisfaction and career intentions of registered nurses in primary health care: an integrative review. BMC Family Practice, 19(1), pp. 1-14. doi:https://doi.org/10.1186/s12875-018-0819-1
3. Hockenberry , J. M., & Becker , E. R. (2016). How Do Hospital Nurse Staffing Strategies Affect Patient Satisfaction? ILR Review, 69(4), 890–910. doi:https://doi.org/10.1177/0019793916642760
4. Krepia, V., Katsaragakis , S., Kaitelidou, D., & Prezerakos, P. (2018). Transformational leadership and its evolution in nursing. Progress in Health Sciences, 8(1), 189-194. doi:https://doi.org/10.5604/01.3001.0012.1114
5. Miller, C. J., Bo, K., Silverman, A., & Bauer, M. S. (2018). A systematic review of team-building interventions in non-acute healthcare settings. BMC Health Services Research, 18(1), 1-21. doi:https://doi.org/10.1186/s12913-018-2961-9
6. Nyssen, A. S., Gillet, A., Sougné, J., Bidee, J., C. Gerimont, Pepermans, R., & Hansez, I. (2018, August 1). Do management and executive share the same perception on the critical issues facing the front-line nursing staff? International Journal of Healthcare Management, 11(3), 239–242. doi:https://doi.org/10.1080/20479700.2017.1353786
7. Samuel, A.-G., & Edward, B. (2016, January 1). Nursing in Ghana: A Search for Florence Nightingale in an African City. International Scholarly Research Notices, 1-14. doi:https://doi.org/10.1155/2016/9754845

Passion, Paths, and Specializations

Ever since I was a little girl, I knew that someday I was going to be a nurse. I have always loved helping people and doing everything I possibly could to learn more to help people. When trying to decide what college was going to be right for me, I knew that I needed to look at the nursing programs of each of my choices because I never had anything else in my mind about not being a nurse.

I have a couple of options that I’m currently deciding between, either UNI and then going to Allen College to do my nursing clinic training or going to the University of Iowa and going to the nursing program they have. They both would be just the right school to help me learn as much as possible and challenge me to be a better person and student within the nursing program. Before taking some nursing classes, I never did much research or thought about nursing. I just knew that I wanted to help people in any way possible.

From the different fields of nursing, I have always loved children and have loved just being involved in any way I could and being hands-on with everything. So as of now, I plan to become either a pediatric nurse practitioner or a trauma nurse. The common task for a trauma nurse is to handle minor and acute problems, prepare patients for emergency operations, and assist surgeons during operations. To me, doing that as a career path just really interests me, and just doing anything in the medical field will make me happy, just knowing I’m helping people is what matters.

Statistics, Career Outlook, and Advanced Practice

“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations” (American Nurses Association). This definition describes exactly what I have wanted to do for some time. I have never really looked at the statistics of nursing as a career and just found Allen’s visit and website very interesting and helpful.

As well as the Occupational Outlook Handbook that, allows me to see the vital statistics of nursing as a career in a quick facts chart. I learned that the median pay for 2014 was $66,640 per year, for 2016 was $68,450, and for 2018 $70,000, and the job outlook is 16%, which is evidently much faster than average. I have always known that there has been a shortage of nursing, and hopefully, as soon as I graduate, I will be able to find a good career fast.

After researching the vital statistics and what nursing is, I went into a little more detail about advanced nursing practice because that is where I hope to be after graduating with a bachelor’s degree. I then would receive my doctorate degree in nursing practice. “Advanced nurse practitioners are highly experienced and educated members of the care team who are able to diagnose and treat your health care needs or refer you to an appropriate specialist if needed” (Hinchliff).

I learned through the article “Advanced or Advancing Nursing Practice: What is the Future Direction for Nursing” that over the past several years, advanced nursing practice has become a much higher demand due to “first, the significant reduction in available doctors; and, second, the rise in numbers of patients with complex health needs.” This hopefully means that when I graduate and become an advanced nurse practitioner that I will be able to help in areas of shortage and allow my abilities to heal and save other people.

A Day in the Life of a Nurse: Challenges and Fulfillment

A typical day for a nurse is when they first arrive at work, one of their first responsibilities is to either speak with the previous night nurse or review outpatient records to get an idea of which and how many patients they’ll be dealing with. Once this has been completed, other preparations are made, which include looking over patient tests that will be administered throughout the day, coordinating schedules with doctors, and checking email.

Once all of this has been completed, premed orders are faxed, and any testing equipment needed for early morning patients is set up. Additionally, if testing equipment is required to be set up, a call is usually made to them to confirm that they will be on time. As time goes on, patients are seen and helped by the nurse, and vitals are taken for all of them. A computer is used to chart patient data, and the nurse works alongside the doctor to administer any testing and assist in whichever way the situation calls for.

Emergencies come up throughout the day that may prevent other, less critical appointments and testing from taking place on time. Roughly around the point of mid-day, lunch is eaten. However, this could be interrupted at any time by a medical emergency that needs immediate attention. A day in the life of a nurse can be hectic, and any nurse will tell you that no two days are the same.

Whenever the emergency subsides, the nurse goes back quickly and consumes the rest of their lunch with what little time they have left. As time creeps into the afternoon, more patients are seen and dealt with. In some cases, non-English speaking patients will bring along translators to help the communication process. Once the nurse gets a chance to breathe between patient emergencies, appointments, testing, and scheduling, he/she can return to their office to catch up on less critical matters, such as emails.

The nurse continues to see patients and check on ICU procedures by reviewing charts and collecting data. Many nurses oversee the collection and recording of data on surgery patients. Amidst doing this, a nurse might continue to check and respond to emails and review the schedule for the following day. Lastly, at the end of the day, the nurse leaves almost entirely depleted of energy. However, they are also filled with a sense of fulfillment for making such a difference in the lives of their patients. The nurse plans to go home and take care of personal matters, and he/she is usually in bed by around nine or ten to ensure there’s enough rest and recharge for the next day.

After doing all this research, I understand more about the career and understand what I need to do to get where I would like to be in my future career. Basically, all I knew before this research was that I wanted to help people on a more personal level than a doctor, and now I for sure that nursing and one of the schools can help me do this.

References:

1. Occupational Outlook Handbook. “Nursing as a career.”
2. Hinchliff, S. “Advanced or Advancing Nursing Practice: What is the Future Direction for Nursing.”

Introduction

Over the years, it is possible many have heard the claims that the number of nurses available does not satisfy the required number of nurses for efficient operation. On the other hand, the reports do not add up as the number of nurses that graduate is at a high rate. However, from an article written by Lenny Ruhl, a clear understanding has been developed of the primary challenge that is making this matter a real hazard (Lenay Ruhl, 2017).

Shortage of Nurses

According to the article, the United States is one of the leading nations that has put its medical and health sector at the forefront of its entire system, even before economics. This is so since the government believes that health is the pillar of economics. Nonetheless, nurses are the main piece of the healthcare sector, which makes it a challenge anytime that nurses are on burnouts or are less in the industry. Below is a discussion and summary of the elements that have been pointed out by the article to be the main reasons that lead to the nation having a shortage of nurses.

Before the introduction of the Affordable Care Act health care insurance policy in 2010, people had access to health care as it was far easier to cater to the bills. Considering that many healthcare sectors have been developed during a time when patients were minimal, the industry is yet to adapt to the increase in patients (Lenay Ruhl, 2017). The rise in patients has also become rampant as a result of new and developed medical technologies that are making it possible for people to live longer and be able to live through any medical conditions.

The education forum has also gradually shifted as a result of new technologies, constant developments, and stern innovations being developed over time. This is an apparent struggle for the medical and nursing units as the educational facilities cannot keep up. This makes it difficult for many nurses to attain jobs as they are not qualified. The notion that the nursing business or career is one that does not offer ample time for anyone to have much freedom is a very challenging factor that causes many people to walk away from choosing a career (Lenay Ruhl, 2017).

All in all, this challenge can be catered for in two unique manners, the first being developing a medical unit that contains nurses that can be able to travel from the pharmaceutical sector to another. The struggle can also be fixed by developing a medical training and learning regime under every medical institution where the nurses can have free time to attend schools and build their careers rather than being laid off or not being offered work. These methods are said to be the best methods to ensure that the medical nursing sector does not crumble.

References:

1. Lenay Ruhl, L.R. (2017). Travel Nurse Source Blog. Retrieved17 January, 2019, from https://www.travelnursesource.com/notes/shortage-of-nurses-in-the-united-states

Central New Mexico Community College

The topic of my choice that I have researched is the nursing shortage that I see during my clinical rotation. There are not always enough nurses on the floor for the acuity of patients who are admitted. The articles I reviewed give reasons on why the shortage exists, how it affects patient care, and how to help new RNs transition into the new role of Registered Nurse. The areas of improvement would be to hire more nursing faculty to teach qualified individuals to advance their training, not to burn out the nurses by giving them a high patient-to-nurse ratio, and building the relationship of new nurses with their preceptors to be able to grow.

Impact of Nurse Shortage on Patient Care and Safety

Patient safety and quality of care are being affected by the shortage of nurses. This is not a recent problem; it has been going on for many years. In fact, the legislation passed the Nurse Reinvestment Act in 2002, the Registered Nurse Safe Staffing Act of 2007 and 2010, and mandated nurse ratios at the State level to encourage nursing growth. The Registered Nurse Safe Staffing Act of 2010 states that it must be based on patient numbers and the intensity of care they need to take into account the level of education, training, and experience of the RNs providing care, ensure that RNs are not forced to work in units in which they are not trained and must consider other factors affecting the delivery of care, including unit geography and available technology.

The bill would also protect RNs and others who may file a complaint about staffing, allow for the refusal of an assignment, and establish procedures for receiving and investigating complaints.” (The American Nurses Association, 2010, p. 2) (Martin, 2015, p. 4). The more nurses available at the bedside, the greater patient satisfaction, improvement of quality of care, an increase in the morale of the nurses, greater job satisfaction, and greater retention rate for the employers. Staffing inadequacy questions the ethical principles of Beneficence and non-maleficence of the nurse by putting patient safety and how they care for a patient at risk. These two principles are the backbone of the way nurses practice. It is not only morally required but legally as well. Not being able to manage the workload and nurse fatigue can cause the disregard of these principles.

Consequences of High Nurse-to-Patient Ratios and Educator Shortage

A high nurse-to-patient ratio is directly responsible for nurses’ job-related burnout and job dissatisfaction. Adverse outcomes of a high nurse-patient ratio include pneumonia, cardiac arrest, shock, and UTI. Lower registered nurse-to-patient ratios are shown to reduce mortality rate by more than 50%” (Sofer, 2005, p.20). (Martin, 2015, p. 4). A workload that is not realistic can result in chronic fatigue, poor sleep patterns, absenteeism, and job dissatisfaction. What some organizations in California have done is they will have more RNs on staff and less unlicensed assistive personnel (UAPs). That, in turn, changes the RN’s duties, which would include housekeeping and transportation. The purpose is not to get rid of ancillary staff but to add more nurses who can care for patients.

One of the reasons that there is a nursing shortage in the State of Texas is because of the lack of nursing educators. The average age of a nurse educator in the United States is 56.4. (Allen et al., 2017.) Retirement for the educators is expected to increase. According to a report from the American Association of Colleges of Nursing, nursing schools turned away 68,938 qualified applicants from baccalaureate and graduate nursing programs in 2014 due to faculty shortage. In the same year, it was found that there were 1,236 faculty vacancies in baccalaureate and graduate nursing programs. In 2015, the National League of Nursing faculty census survey found there were 1,072 faculty vacancies in all types of nursing schools. (Allen et al., 2017.)

Fostering Successful Nurse Transition and Retention

The transition between a Nursing Student and an RN is facilitated by structure and socialization. The structure consists of new Graduates having a safe environment where they are able to share experiences and ask for guidance. Socialization has a support system that includes a nurse educator, preceptor, and fellow staff. According to The University of New Mexico, 17.5% of newly licensed nurses only work for one year, while 43% of newly licensed nurses leave the hospital within three years of starting. (Blevin, 2018 p.199).

Encouragement is needed for new nurses; having a trusting relationship with the preceptor and nurse educator can promote communication if there is lateral violence in the workplace. It is important to have consistency with preceptors because new nurses can feel like they are being bounced around if there are multiple preceptors. Having this consistency helps the new nurse build their confidence and helps the preceptor provide feedback and opportunities to grow.

References:

1. Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing, 24(2), 4–6. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103796942&site=ehost- live&scope=site
2. Allen, P., Sportsman, S., Batchellar, J., Boswell, C., Cannon, S., Evans, M., Starlin, M., Valerio, J. (2017). THE NURSING FACULTY SHORTAGE: What Is Being Done in Texas? Texas Nursing, 91(3), 12–14. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125191895&site=ehost- live&scope=site
3. Blevins, S. (2018). From Nursing Student to Registered Nurse: The Challenge of Transition. MEDSURG Nursing, 27(3), 199–200. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=130397407&site=ehost- live&scope=sitec

Challenges, Rewards, and Shortages

Nursing is a profession that many aspire to pursue. Nurses are well-trained to take care of patients and offer advice to individuals on ways to keep fit. For an exceptional job in the nursing profession, nurses need to be ready to meet the numerous challenges that exist in the healthcare sector. According to scholars, individuals seeking to be nurses need to be dedicated at all times and always be at their best while working since their work deals with people’s lives. Like any other profession, nursing has its own rewards and challenges. For instance, the ability of nurses to connect with people suffering from different illnesses is rewarding. Through such connections, an intimate level is created. According to the research findings, there has been a shortage of trained nurses. This has affected the modes of operations in the healthcare sector.

Nurse Shortage Impact & Strategies

Research in the healthcare sector has been directed at finding out major contributing factors that have resulted in the nursing shortage. The shortage of qualified healthcare practitioners, such as nurses, affects the modes of operation within the healthcare sector. Factors such as high nurse-to-client ratios and stress in the workplace make it challenging for hospital managers to retain qualified nurses (Cherry & Jacob, 2016). To solve this menace, nurses are offered continuing education, and effective reward systems have been introduced in the healthcare sector.

This specialized training and incentives play a vital role in ensuring quality nursing care is achieved. Nowadays, hospitals are keen on creating and maintaining a high level of client care. Additionally, hospitals have in mind that effective customer care is the best way of maintaining their clients. Effective customer care translates to effective medical care. To achieve this, there is a need to retain nurses by enforcing actions such as equipping hospitals with modern healthcare technology and facilities is a measure of retaining nurses. Healthcare facilities help nurses perform incredible tasks, such as diagnosing diseases.

From a study by AMN Healthcare, 83 percent of nurses are satisfied with their choice regardless of the challenges they encounter daily (Reid, 2018). For example, nurses’ shifts are demanding. Unlike other professions, there exists no specific routine for nurses. The wide range of responsibilities that need to be performed by a nurse in a hospital or a medical facility is dictated by the kinds of patients they interact with. After interacting with the patients, nurses lay out procedures that will be followed during medical care. Surgeries are more demanding as compared to minor procedures. All procedures require a strict care schedule. Failure to adhere to the schedule will lead to ineffective medical care. Patients are attracted to hospitals that offer quality medical care. Quality medical care reduces the mortality rate in hospitals.

Nurse Job Satisfaction & Retention

Another factor that has contributed to the nursing shortage crisis is the failure of hospital managers to offer qualified nurses job satisfaction (Black, 2016). A decrease in job satisfaction makes nurses leave the client care setting, causing the crisis. The solution to retaining qualified nurses is to improve their work conditions (Cherry & Jacob, 2016). Improving the work conditions for nurses also helps reduce job stress. According to scholars, job stress contributes to other job-related problems, such as poor work performance. To improve nurse’s work performance, hospitals need to introduce motivation and reward systems that favor the roles and responsibilities of nurses.
According to scholars, both psychological and non-financial rewards play a critical role in nursing.

In particular, rewards and appreciation motivate nurses to work hard. There is a need for hospital managers to introduce efficient reward systems for nurses to boost their performance (Black, 2016). An efficient reward system for nurses comprises all the reward categories. However, most hospitals and medical facilities offer financial rewards only. Research findings indicate that a larger percentage of qualified nurses want to associate themselves with hospitals and medical facilities that provide quality medical care to visiting clients.

Continuing education is essential in improving nursing skills. Through continuing education, nurses are offered an opportunity to learn new skills that will improve their service delivery to patients (Cherry & Jacob, 2016). From taking part in continuing education, nurses are educated on how to handle new equipment that will be helpful in day-to-day activities. Hospital managers need to create a conducive working environment that will unite all staff members. This promotes teamwork, thus encouraging a proper relationship between the staff members and patients.

Despite the numerous challenges in nursing, nurses play a crucial role in making a difference in people’s lives through the constant interactions developed (Salminen et al., 2016). It is, therefore, essential for hospital managers to ensure that hospitals are well-equipped with new facilities that will ease the workload of nurses. This requirement will ensure a conducive working environment for nurses is achieved. Continuing education platforms and efficient reward systems help improve the work performance of nurses in a great way. Nowadays, hospitals focus on recruiting more nursing professionals to help reduce the workload in the healthcare sector. Both the government and hospitals have introduced effective measures that will help retain nurses in hospitals in order to curb the shortage of nurses that has been on the rise.

Conclusion:

In conclusion, the numerous challenges within the nursing profession have affected healthcare service delivery. As a result, relevant authorities have established different measures that will help curb further challenges in the healthcare sector. Also, advancements in healthcare technology have greatly reduced the workloads that previously existed in nursing. Rewards influence work-related behavior within an organization (Odelius et al., 2017). Rewarding nurses helps boost their work performance by motivating them to work hard. As discussed, to improve the work performance of nurses, there is a need for hospitals to address nurse’s concerns. The nursing profession plays a crucial role in enabling the well-being of patients. Hospitals and government institutions have collaborated to ensure that nurses no longer encounter challenges that affect their work performance.

References:

1. Black, B. (2016). Professional Nursing-E-Book: Concepts & Challenges. Elsevier Health Sciences.
2. Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.
3. Odelius, A., Traynor, M., Mehigan, S., Wasike, M., & Caldwell, C. (2017). Implementing and assessing the value of nursing preceptorship. Nurs. Manag.(Harrow), 23(9), 35-7.
4. Reid, L. (2018). What it’s REALLY like to be a nurse, one of the most satisfying and in-demand jobs in America right now. [online] Pulselive.co.ke. Available at: https://www.pulselive.co.ke/bi/strategy/what-it-s-really-like-to-be-a-nurse-one-of-the-most-satisfying-and-in-demand-jobs-in-america-right-now-id8266781.html [Accessed 3 Sep. 2018].
5. Salminen, H., Bonsdorff, M. V., Koponen, S., &Miettinen, M. (2016). Perceived development opportunities and reward satisfaction as antecedents of nurses’ job withdrawal intentions. International Journal of Work Innovation, 1(4), 330-352.

Introduction

The biggest challenge for Hong Kong’s health care system is to provide an efficient service for patients. On 20 January 2019, around one hundred members of the Association of Hong Kong Nursing Staff gathered outside government headquarters to voice out the problems of critical manpower shortage and lack of ward space and resources. The chairman of the Association of Hong Kong Nursing Staff, Joseph Lee Kok Long, said the ratio of nurses and patients is 1:10. The problem even became worse during the flu season. Besides, there is a growing number of medical malpractices. The Government of Hong Kong Special Administrative Region reported that the total number of medical errors was 192 in 2018 and 2017.

To improve these problems, Evidence-based practice (EBP) is a problem-solving approach that can guide nurses to enhance their knowledge and provide high-quality care for patients. It is based on multiple research and generates valid and in-depth evidence to discover whether there are any improvements in some traditional nursing care. Florence Nightingale was a pioneer of nursing and a reformer of sanitary methods. She decreased the mortality rate, which was caused by unsanitary conditions, by doing data analysis (Cohen March 1984).

However, there are several obstructions that affect nurses’ will to implement EBP. EBP has numerous advantages for the health care system, so this essay aims to identify the barriers to the implementation of EBP and the solution to curtail the gap between clinical practice and research. Barriers to the Implementation of Evidence-Based Practice in Nursing

Lack of time

One of the limitations is there is a lack of time for nursing staff to do research findings and analyze multiple literature reviews. The major reasons are heavy workload and imbalance in the health workforce.

Iran Zahedan Teaching Hospitals progressed. A cross-sectional study in 2014 showed that of two hundred and eighty nurses, 83.7% of them agreed that they do not have extra time to read various types of research during their working hours. Also, 190 of them agreed that they had a heavy workload (Mohammad et al., 2014).

In Hong Kong, nurses need to work eight hours a day and four to five nurses in one duty session. In the ward, the average patient number was around fifty. Nurses needed to do numerous tasks in the limited hours. For example, assist disabled patients in bathing, feeding, Foley care, wound dressing, administering medication, etc. Every nurse is forced to multitask at the same time. They cannot focus on one task and appear uncontrollable, thinking about what to do next.

Therefore, how can they read the research findings in an inadequate working time? A nurse interviewed by SCMP said: “Each nurse has to take care of more than twenty patients at the same time. Consequently, the quality of health care service would be influenced, and it may increase the chances to make faults.” Although EBP is a good way to deal with the increasing medical malpractice, the major problem is limited manpower and heavy workload.

Four hundred and fifty-eight nurses who were employed in a medical center in California indicated that they had finite time for evidence‐based practice during scheduled working hours because the patient’s health conditions were changeable and unpredictable (Caroline et al., 2009). In a psychiatric ward, patients tend to be less stable than in a general ward. Some of them are suffering from schizophrenia, attention deficit hyperactivity disorder, bipolar disorder, etc. They have high suicidal ideas, a risk of violence, and some aggressive behavior. Therefore, a nurse has to close observation and restrain them in some situations. It is dangerous if a nurse not be aware of the patient’s whereabouts continuously. Therefore, it is hard to implement an EBP.

Considering the time limit, some may say nurses can read the research at home after work. However, few of them will sacrifice their leisure time to do EBP. They would rather finish their personal issues and take a rest than read literature reviews at home(Caroline et al., 2009). Furthermore, lack of time is not only related to reading research findings but also to the time to implement the changes of practice.

Limited support

The key elements of generating an EBP are encouragement and support (Fathimath, 2014). Most of the nurses are not familiar with EBP and think that they are short of the skills to carry out change (Rodgers, 1994). They have inadequate skills in estimating evidence and lack the skills to acquire research and evaluate its accuracy. So, they are not confident enough to implement change in traditional nursing skills or guidelines. Clinical nurses can enhance their confidence in research skills and motivation unless they get adequate support from the organization and peer staff.

Support means resources and mentoring (Caroline E, 2009). In the resources aspect, it is hard to find literature reviews on the Internet because most of the books need to be paid for the full vision. Not all the resources are free of charge, and you need a desktop to read full-text articles. In Hong Kong, the funding of the healthcare system is in shortage. There is no additional money to buy research sources and expand the resource allocation on research. The Hospital Authority of Hong Kong is facing the challenges of limited funding and an increasing number of admissions. The resources cannot meet the demands. In January 2018, HA arranged 569 time-limited beds for major specialties wards and 1122 temporary beds for acute hospitals. However, the bed shortage problem still occurs and is even worse.

In the mentoring aspect, there are less knowledgeable and experienced advanced practice nurses or researchers to guide people on how to read research effectively and use evidence-based to change the caring method in the clinical setting. The research actually is vanity because the authors do not provide the method of applying those skills in clinical practice (Patricia, 2009). As a reason, nurses cannot discover the value of reading research and the benefits of clinical.

The culture of EBP

Some nurses have misunderstandings about EBP. They would rather follow traditional nursing skills than use the new skills. Nurses’ lack of acceptance of the evidence is possible to bring advantages to patients (NICE, 2007). Nurses who have worked for more than five years. They are confident enough to use current knowledge and clinical experience to overcome different challenging situations. When they adapt to the sudden modification, others will misinterpret the reason for the change as what nurses have done before was not effective and professional enough.

Moreover, they are not willing to take the risk of change. When the modification brings about unexpected incidents, for example, a slower rehabilitation rate, death, or medical errors. Who will take the responsibility and accountability? This approach is influencing not only individual patient care but also the stability of the whole healthcare system’s development.

EBP is seen as a time-consuming method. It takes a long time to obtain significant outcomes. Consequently, when there is no improvement shown in this long period, it is a waste of time. To prioritize the urgent needs of the health care system and the need for modification. The present problems are more imperative.

The solution to overcome barriers

Leadership is important for generating an EBP (González, 2012). According to the barrier of limited support, Hospital authority can arrange for knowledgeable nursing staff allocated in different hospitals regularly. The aims are to share multiple visions of the multihospital system and learn strengths and shortages from another ward. An experienced nurse can act as a mentor for the implementation of EBP. To guide the junior staff and answer questions about research findings, the way to apply the evidence effectively, and find the best available evidence (Dalheim, 2012).

Education also vials for the implementation of EBP and the culture of doing research, according to the barrier of culture change. There are obvious differences between nurses with master’s degrees and nurses with bachelor’s or associate degrees. Advanced, certificated nurses who are in leadership roles have more positive attitudes and greater acceptability toward EBP (Warren, 2016). Therefore, establishing a course about EBP in the college’s nursing programs can resolve the misunderstanding and change the culture fundamentally.

On account of teaching nursing students EBP development in nursing, classify the type of evidence, the steps to implementation, etc. Besides, fresh graduate and nurses with fewer years of experience are more positive to EBP as EBP become a major course in the undergraduate nursing program. HA can encourage them to share what they have learned with older and more experienced nurses who have not participated in the EBP project. For the barrier of limited resources, organizations can collaborate with local colleges. Allow nurses to read and borrow resources from colleges’ libraries. So that no extra cost is needed and make good use of existing resources in Hong Kong.

References:

1. Cohen, M. M. (1984). Nightingale’s recommendations on noise in the hospital. Applied Nursing Research, 1(1), 4–10.
2. Mohammad, M., Mahsa Haj, S., Zahra, K., Shahab, M., & Fatemeh, E. (2014). Obstacles and Facilitators in Implementing Evidence-Based Nursing Practice in Iran. World Applied Sciences Journal, 31(8), 1444-1449.
3. Caroline E. Brown. (2009). Implementing evidence-based practice in psychiatric nursing. Issues in Mental Health Nursing, 30(3), 151-155.
4. Fathimath, A. S., Athira, K., & Uma, D. (2014). Barriers to implementation of evidence-based practice in Maldives: an exploratory study. International Journal of Nursing Education, 6(1), 1-6.
5. Rodgers, H. (1994). Diffusion of Innovations. J Med Libr Assoc, 82(2), 163.
6. González, S. A. (2012). Leadership behaviors influencing evidence-based practice implementation. Worldviews on Evidence-Based Nursing, 9(4), 219-226.
7. Dalheim, A., Harthug, S., Nilsen, R. M., Nortvedt, M. W., & Factors, A. (2012). Factors influencing the development of evidence-based practice among nurses: A self-report survey. BMC Health Services Research, 12(1), 367.
8. Warren, J. I., Mulholland, M., Bakken, S., & Ruland, C. M. (2016). Nursing Students’ Perspectives on the Use of Evidence in Practice: A Cross-Sectional Study. Journal of Professional Nursing, 32(6), 455-464.

“Comparative Analysis of Nursing Shortage” by Lauren Littlejohn, Jacquelyn Campbell, and Janice Collins-McNeil

The authors of the article provide a comparative analysis of the problem of nursing shortage in three countries around the world, including the United States, the Philippines, and South Africa. Moreover, they offer a logical background of the issue by indicating that it has become a global challenge. Indeed, the article remains informative, as it recognizes the impacts that the nursing shortage has, including increased suffering of patients, as healthcare providers are not prepared sufficiently to care for their needs. Moreover, the authors support their point by providing relevant statistics from around the world and major examples that highlight the causes and impacts of the problem.

The research gap seems clear in this article, as it acknowledges the fact that despite shallow knowledge on the matter, little is known concerning the worldwide causes of the declining professional nurse workforce. The authors use an effective approach for this kind of scientific research following the rightful standards. The initial objective of the study was to investigate the notion that within each nation, the issue of nursing shortage is a result of several factors that ultimately lead to a decline in the quality of healthcare provided.

The authors end up with relevant results that affirm their hypothesis that the problem in the three countries is diverse but has common effects on healthcare models. In this way, this article is quite critical and analytical, which means that it meets the requirements of standard scientific research that incorporates a current healthcare issue, which is the nursing shortage around the world.

Evaluation of Research Methods

The authors provide an informative literature review that incorporates a wide array of research resources. It is based on the work of four researchers by utilizing a peer-reviewed approach. Furthermore, the published literature was determined by looking for certain bibliographic databases, including Sage, CINAHL, PubMed, and OVID (Littlejohn et al., 2012). All the articles are from 2002 up to the publication date. The literature review is also restricted to major research topics that align with the main study area of nursing shortage.

Indeed, this is an effective approach in scientific research to avoid deviating from the main course. The authors achieved this by identifying the most critical topics, including global nursing shortage, international nursing, brain drain, as well as healthcare models (Littlejohn et al., 2012). The literature review is well organized to depict the major aspects of research, which are the causes and effects of the problem being addressed. The scholars do well by subdividing the section into three others to make it more coherent and comprehensible.

The diverse sub-sections achieve their targets, as they are connected with the main topic of nursing shortage. All of them attempt to bring out the comparative aspects of the research to allow a reader to understand the similarities and differences that exist between the three nations. In effect, the literature review is developed effectively, thus enhancing the article to meet its objective of providing sufficient knowledge on the subject.

The research article was published in 2012, which makes it current and relevant to modern health issues. The nursing shortage is a critical concern that is affecting nations around the world in today’s globalized system. The nurse-to-patient ratio in many countries is not within the required range. In this case, one nurse deals with many patients simultaneously, which can lower the efficiency and quality of healthcare. For instance, emergency departments require this ratio to be as small as possible to increase the speed and quality of care for critically ill patients (Cherry & Jacob, 2016).

However, this has not been the case today in many nations to the point where one nurse attends to more than nine patients. Therefore, the nursing shortage is a relevant and current issue that requires urgent attention. In fact, some nations, such as the United States, are encouraging diploma nurses to undertake degree courses to increase their knowledge and be able to meet the current requirements of a diverse and dynamic environment (Cherry & Jacob, 2016). Other emerging issues, including an increasingly elderly population that seeks medical attention, are an indication of increased complexity in the healthcare sector. Essentially, the article articulates major and significant information that meets the needs of the current healthcare sector.

The authors applied the peer-reviewed search approach to conduct their empirical literature analysis. The scholars looked at already published literature by identifying different bibliographic databases. All the information obtained was aimed at depicting the comparative factors among the three nations of interest, including South Africa, the Philippines, and the United States (Littlejohn et al., 2012). The text relies on a wide array of empirical evidence from already-done research.

The authors also had a timeline that they followed to ensure that all the data that they obtained was up to date and aligned with the research problem. Just as required in comparative analysis, the major points should come out clearly to depict either the differences or similarities of the aspects. The scholars achieved this in their research method, as they focused on the effects and causes of nursing shortages in the three nations. Therefore, the approach of study used in the article fits this kind of scientific investigation.

The population identified for this research was a nursing shortage in three nations. The sampling was quite structured, as it was restricted to scientific databases, including OVID, Sage, PubMed, and CINAHL (Littlejohn et al., 2012). The approach restricted researchers from obtaining widely varying data. However, it enables one to get concise information that can be easily compared to determine the efficiency it carries.

The sampling method used for this research was appropriate in the sense that it represented three major continents, including America, Africa, and Asia. Indeed, this was a wise selection by the authors to ensure that they showed rich knowledge regarding the issue of nursing shortage. The samples identified for this research also represented large populations of the three continents. The selection was also an indication that the issue of nursing shortage is widely affecting both developed and developing nations. Thus, the sampling method was quite an effective one, as it covered a wide representation of major aspects not only in the three countries and continents but also around the world.

The article represents a practical work executed by professional scholars. The authors suggest that understanding the nursing shortage is important, as it helps understand the causes and effects that it brings around the world. The authors are keen to note that the results are quite relevant in the modern world, as they showcase the ongoing issues in the healthcare sector. Understanding the varying causes of nursing shortages in various nations is quite practical since different regions are affected by diverse issues.

Most importantly, the authors acknowledge this by depicting what affects diverse countries, which is a representation of three continents. The work is also practical since it indicates that the effects are similar despite the diverse causes of the problem (Littlejohn et al., 2012). It is an indication that the consequences are being felt far and wide; thus, there is a need to seek urgent solutions for this issue. Therefore, the authors present a logical article that develops practical factors associated with the nursing shortage as a global problem.

Every research has its limitations, which are indications that it can be improved. The authors of this text only provided recommendations for both the United States and South Africa. Essentially, it means that they left out the Philippines. It is also evident that they suggested that their recommendations exceed the limitations of the research. Therefore, there are improvements that should be made, including highlighting suggestions for finding solutions in the Philippines. Furthermore, the authors should have laid down a platform for future research on the topic of the nursing shortage that keeps on developing nowadays. In fact, it is a wide subject that requires deep analysis and study to help reach final solutions that would help resolve it.

The writing in the article is clearly straightforward, as the authors have laid down critical matters surrounding the nursing shortage in the three countries. The language used is comprehensible and easy to understand. The materials used can be accessed easily from the mentioned databases. Furthermore, scientific terminologies help understand the meanings. In other words, the entire research presents readers with an efficient platform where they can obtain relevant knowledge on the topic.

Further research can be conducted regarding this topic, especially on nurse-to-patient ratio. In such a case, a researcher can decide to explore the effect of nurse-to-patient ratio on healthcare quality and delivery. Moreover, there can also be the determination of the reduction or increment of the ratio in emergency or critical care departments. Such studies would be relevant to have a better understanding of the issue of nursing shortage in the world.

Conclusion

In general, the article presented in this critique is a relevant and logical one, as it addresses a current healthcare issue not only in the three countries but also around the world. It is an up-to-date resource, as it was published in 2012. The strength of the literature review comes out clearly, as the article is analytical and uses reliable databases for the review of resources. The method used has been highlighted clearly in the article, which fits the nature of the research done. The sampling is also a major representation of a wide array of populations representing three major continents. Essentially, the article is quite effective.

Reference:

1. Littlejohn, L., Campbell, J., & Collins-McNeil, J. (2012). Comparative Analysis of Nursing Shortage. Journal of Global Health Care Systems, 2(3), 1-15.
2. Cherry, B., & Jacob, S. R. (2016). Contemporary Nursing: Issues, Trends, & Management (7th ed.). Elsevier.