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Nurse Staffing Ratios and Patient Outcomes
Effect of nursing shortage on patient care
Staff shortage as a nursing issue
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These articles have many similarities when discussing the issue of staffing shortages. For patients, their loved ones and the general population, they don’t understand the ramifications and strain that staffing shortages have on nurses. People expect and deserve complete, competent and safe care when they are patients. These articles bring to light all the struggles that nurses have to deal with. Nurses are fearful that they will make mistakes, will harm patients, and will harm themselves. (Bae, 2012; Erlen, 2001; Martin, 2015) Overtime can be overwhelming and exhausting, which can lead to errors being made. (Bae, 2012; Erlen, 2001) These articles perceive that it may be beneficial for nurses, patients, and healthcare facilities to decrease the nurse-to-patient ratio, however, this option is not always …show more content…
feasible. (Douglas, 2010; Erlen, 2001; Martin 2015) There are many different solutions to the nursing shortage being evaluated for effectiveness, many have possibilities and many fall short. (Bae, 2012; Douglas, 2010; Erlen, 2001, Martin, 2015) These articles do point out differences as well. Douglas (2010) states that nurses need to “build trust and strong collaboration between finance and nursing” in order to make a difference in patient safety and care. (p.7) Erlen (2001) states that “nurses cannot expect nor should they want others to find the solutions to the nursing shortage. For in so doing nurses may find that the solution is not in the best interests of their profession or patients.” (p.5) Currently in Colorado the law states that, “at least one registered nurse shall be on duty at all times in each patient care unit. Additional registered nurses, licensed practical nurses, or other auxiliary personnel shall be available.” (Health Facility and Emergency Medical Division, 2014). This requirement doesn’t have enough specifications to allow any nurse to have a safe ratio of patients when staffing is short. Since the Nurse Practice Act was passed, the Board of Nursing (1903) legislates, directs and controls nursing. The Nurse Practice Act has determined a framework and guidelines nurses. It grants nurses the authority to carry out those functions to abide by to ensure safety and protection of patients. The Nurse Practice Act considers and determines all disciplinary procedures. Board of Nursing (1903) Unrealistic nurse to patient ratios increase workloads, which increase stress and fatigue, creating the risk for errors to occur, and patients may suffer adverse outcomes. (Croke, 2003, p.55; Douglas, 2010, p.5; Halm et al., 2005, p.243; Martin, 2015) A nurses’ license is in jeopardy in any situation resulting in patient harm. (Croke, 2003) Ethical dilemmas are situations requiring a choice be made between two different sets of values.
Are nurses able to ‘do no harm’ when nursing care is missed? The ethical responsibility of nurses. Provisions 3 & 4 of the Code of Ethics states that the nurse promotes, advocates for, and protects the rights, health, and safety of the patient; and the nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. (American Nurses Association, 2015) Nurses want to give complete and quality care, but are unable to, due to the constant needs of their workload and inadequate staffing. They have to prioritize their patients needs based on the most critical treatments first. Then whatever time is left, they fill in what treatments they can. Some reasons that nursing treatments are missed include: too few staff, time required for the nursing intervention, poor use of existing staff resources and ineffective delegation.” (Kalisch, 2006) Many nurses become emotionally stressed and unsatisfied with their jobs. (Halm et al., 2005; Kalisch,
2006)
A code of ethics provides a standard by which nurses conduct themselves and their practice, observing ethical obligations of the profession and providing quality care. To achieve its purpose, a code of ethics must be understood, internalized, and used by nurses in all aspects of their work” (Aliakvari, 2015, p. 494).
Ethics are rules of behavior based on ideas about what is morally right and wrong.(Merriam) The nurse is responsible primarily for the patient. Nurses need to promote, advocate for, and strive to protect the health, safety, and rights of the patient.(FUN) The Dax Cowart Case is the perfect example of the need for autonomy, informed consent, and quality of life.
Gordon, S., Buchanan, J., & Bretherton, T. (2008). Safety in Numbers: Nurse-to-Patient Ratios and the Future of Health Care (pp. 1-2). Ithaca, NY: Cornell University Press.
It is the nurse’s duty to provide optimal care, take the right action, and deliver quality nursing care. Professional and ethical actions promote the best possible patient outcomes.
According to Arries & Cur (2005), “the virtue ethics in nursing can be viewed as an approach of ethical deliberation about the moral character and dispositions of nurses as moral agents that enables them, as virtuous human beings, to fulfill their purpose and function as professional people.” The nurse exercises virtues of honesty, truthfulness, benevolence and moral courage to fulfill code of ethics and address ethical dilemmas. According to ANA Code of Ethics for Nurses and Interpretive statements (2015) “nurses are leaders who actively participate in assuring the responsible and appropriate use of interventions to optimize the health and well-being of those in their care. This includes acting to minimize unwarranted, unwanted, or unnecessary
The Code of Ethics for Nurses was created to be a guide for nurses to perform their duties in a way that is abiding with the ethical responsibilities of the nursing profession and quality in nursing care. The Code of Ethics has excellent guidelines for how nurses should behave, however; these parameters are not specific. They do not identify what is right and wrong, leaving nurses having to ultimately make that decision. Ethics in nursing involves individual interpretation based on personal morals and values. Nursing professionals have the ethical accountability to be altruistic, meaning a nurse who cares for patients without self-interest. This results in a nurse functioning as a patient advocate, making decisions that are in the best interest of the patient and practicing sound nursing ethics.
According to American Nurses Association (ANA), (2010) “the nurse promotes, advocates for and strives to protect the heath, safety and right of the patient” (p. 6). Nursing responsibilities should be acted at the highest standard and must be based on legal and ethical obligations.
Thousands of nurses throughout the nation are exhausted and overwhelmed due to their heavy workload. The administrators do not staff the units properly; therefore, they give each nurse more patients to care for to compensate for the lack of staff. There are several reasons to why
The purpose of this paper is to address the issue of nursing staffing ratios in the healthcare industry. This has always been a primary issue, and it continues to grow as the population rate increases throughout the years. According to Shakelle (2013), in an early study of 232,432 surgical discharges from several Pennsylvania hospitals, 4,535 patients (2%) died within 30 days of hospitalization. Shakelle (2014) also noted that during the study, there was a difference between 4:1 and 8:1 patient to nurse ratios which translates to approximately 1000 deaths for a group of that size. This issue can be significantly affected in a positive manner by increasing the nurse to patient ratio, which would result in more nurses to spread the work load of the nurses more evenly to provide better coverage and in turn result in better care of patients and a decrease in the mortality rates.
Factors such as, heavy workloads, stress, job dissatisfaction, frequent medical errors, and intention of leaving the job are all common for nurses to experience, especially during the nursing shortage crisis. Not only do the nurses suffer during a shortage, but the patients ' health outcomes suffer even more. For instance, there are higher rates of infectious diseases and adverse patient outcomes, such as urinary tract infections (UTIs), upper gastrointestinal bleeding, shock, pneumonia, prolonged hospital stays, failure to rescue, and mortality. As a result, this leads to higher re-admission rates for patients. Furthermore, high patient-to-nurse ratios cause heavy workloads due to an inadequate supply of nurses, an increased demand for nurses, a reduction in staffing and an increase in overtime, and a shortened length of stay for patients. Without the heavy workloads that nurses have to endure on a daily basis, there would more time for nurses to communicate more effectively with physicians, insurance companies, and patients and their families. Those heavy workloads are the result of hospitals reducing the nursing staff and implementing mandatory overtime policies just to meet unexpectedly high demands. Unfortunately, the nursing shortage has affected nurses ' mental and physical health. For example, the most common health concerns for nurses include cardiovascular health, occupational injuries and illnesses, and emotional and physical exhaustion. Therefore, safe-staffing ratios/levels have to become the main
Registered nurses abide by a code of ethics as set forth by the American Nurses Association. Some of the ethics nurses live out are: commitment to the patient, practice with compassion and respect, accountability and responsibility for owns actions and collaborating with other health care providers (Code of Ethics for Nurses, 2015). Nurses practice the code of ethics on a routine basis by employing the six fundamental concepts established by the Quality and Safety Education for Nurses (QSEN).
Ethics asses the values, morals, and principles of nurses. Legal codes or laws are rules established by our government. It’s important that nurses have a clear and comprehensive understanding of ethical and legal codes within their career. The understanding of these codes is essential for nurses to safely practice and to protect their patients. Nurses must abide by these principles or face the consequences of legal action. These principles include autonomy, utilitarianism, confidentiality, and many others. Autonomy is the agreement to respect ones right to determine a course of action, while utilitarianism is what is best for most people as defined in American Nurses Association. In order to give you a
The nursing code of ethics has a very standard definition. It is the base on how nurses should guide themselves in conduct by making the right decision regarding ethical issues. According to the National Student Nurses Association “students of nursing have a responsibility to society in learning the academic theory and clinical skills needed to provide nursing care” (2003). In the clinical setting nurses have a lot of responsibilities while caring for an ill patient, they have the obligation to practice their profession with compassion, love, and respect the uniqueness of each patient, as nurses we are not supposed to deny care to a patient because of their economic status, their skin color, race, or the nature of health problems, we are here to help the people in need in particular those of susceptible populations. The NSNA states that the code of conduct is based on an understanding that to practice nursing as a student is an agreement that trust and honesty is depended on us by society. The announcement of the code provided direction for the nursing student in the personal development of an ethical foundation and not limited to the academic or clinical environment but can assist in the holistic development of a person. (National Student Nurses Association, 2003)
In the code of ethics, the very first ethical principles that nurses are expected to uphold in order to exemplify that they are competent professionals are autonomy, beneficence, and nonmaleficence. That is, nurses as professionals are expected to advocate for their patients while preserving their respect and dignity and
The American Nurses Association created guidelines for the profession including, a set clear rules to be followed by individuals within the profession, Code of Ethics for Nurses. Written in 1893, by Lystra Gretter, and adopted by the ANA in 1926, The Code of Ethics for Nurses details the role metaethics, normative ethics, and applied ethics have within the field (ANA, 2015). Moral obligation for an individual differs within professions than it does within an individual’s personal life, so the code of ethics was written to establish rules within the profession. The moral obligation to provide quality care include the fundamental principles of respect for persons, integrity, autonomy, advocacy, accountability, beneficence, and non-maleficence. The document itself contains nine provisions with subtext, all of which cannot be addressed within this paper however, core principals related to the ethical responsibilities nurses have will be