NURS 6053 Week 1 Discussion Review of Current Healthcare Issues
NURS 6053 Week 1 Discussion Review of Current Healthcare Issues
NURS 6053 Week 1 Discussion Review of Current Healthcare Issues
National Healthcare Issue: COVD-19
COVD-19 pandemic currently has greatly impact Healthcare. According to the COVID-19 In December 2019, a pneumonia caused by a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China and has rapidly spread around the world since then.
Stressor to focus on
According to the COVID-19 surges have stressed hospital systems and negatively affected health care and public health infrastructures and national critical functions. Resource limitations, such as available hospital space, staffing, and supplies led some facilities to adopt crisis standards of care, the most extreme operating condition for hospitals, in which the focus of medical decision-making shifted from achieving the best outcomes for individual patients to addressing the immediate care needs of larger groups of patients. When hospitals deviated from conventional standards of care, many preventive and elective procedures were suspended, leading to the progression of serious conditions among some persons who would have benefitted from earlier diagnosis and intervention.
The conditions of hospital strain during July 2020–July 2021, which included the presence of SARS-CoV-2 B.1.617.2 (Delta) variant, predicted that intensive care unit bed use at 75% capacity is associated with an estimated additional 12,000 excess deaths 2 weeks later. As hospitals exceed 100% ICU bed capacity, 80,000 excess deaths would be expected 2 weeks later.
According to Vahedian-Azimi, et al., (2017) stress has anegative impact on both nurses and patient outcomes; with a greater impact to those working in critical care areas. Hospitals reported a range of strategies to address their challenges and identified areas in which further government support could help as they continue responding to the pandemic. Broadly, the areas of government support included enhancing knowledge and guidance on the prevention and treatment COVID-19, including safe means to discharge patients with COVID-19; helping to fill gaps in hospital staffing, especially for nurses and certain specialists; continuing financial relief, especially to increase care to rural and underserved communities; and, encouraging widespread vaccinations to reduce the circulation of the virus.
Beyond the immediate needs in responding to COVID-19, the pulse survey documents hospitals’ perspectives about longer-term opportunities for improvement to address challenges that existed before, and were exacerbated by, the pandemic. These include reducing disparities in access to health care and in health outcomes; building and maintaining a more robust health care workforce; and strengthening the resiliency of our health care system to respond to pandemics and other public health emergencies and disasters.
Reducing Stress on Healthcare
According to the ANA The balance of safety and efficacy and the perception of personal risk versus overall benefit are at the core of acceptability of immunization practices. The known and potential benefits of a COVID-19 vaccine must outweigh the known and potential risks. ANA strongly recommends that registered nurses be vaccinated against COVID-19. All health care personnel (HCP), including registered nurses (RNs), should be vaccinated according to current recommendations for immunization of HCP by the CDC and Association for Professionals in Infection Control and Epidemiology (APIC). ANA also believes that it is imperative for everyone to receive immunizations for vaccine-preventable diseases as vaccines are critical to infectious disease control and prevention. Moreover, nurses have a professional and ethical obligation to model the same health care standards they prescribe to their patients. There is now significant clinical evidence on the safety and effectiveness with approved COVID-19 vaccines being administered under the Food and Drug Administration’s (FDA) Emergency Use Authorization process.
Annals of Internal Medicine stated We need to be more aggressive about respiratory hygiene and placing restrictions on patients, visitors, and health care workers with even mild symptoms of upper respiratory tract infection. Potential policies to consider include the following: 1) screening all visitors for any respiratory symptoms that may be related to a virus, including fever, myalgias, pharyngitis, rhinorrhea, and cough, and excluding them from visiting until they are better; 2) restricting health care workers from working if they have any upper respiratory tract symptoms, even in the absence of fever; and 3) screening all patients, testing for all respiratory viruses (including SARS-CoV-2) in those with positive screening results regardless of illness severity, and using precautions (single rooms, contact precautions, droplet precautions, and eye protection) for patients with respiratory syndromes for the duration of their symptoms regardless of viral test results. A collateral benefit is that if a patient is subsequently diagnosed with COVID-19, staff who used these precautions will be considered minimally exposed and will be able to continue working.
Conclusion
Laureate education (2015) states, that one thing that individuals and leaders can do to be prepared for healthcare challenges of the future is to develop cultural competency, gain skills to view multiple perspectives, and develop greater understanding the survival side of any healthcare organization. Having Beyond the immediate needs in responding to COVID-19, the pulse survey documents hospitals’ perspectives about longer-term opportunities for improvement to address challenges that existed before, and were exacerbated by, the pandemic. These include reducing disparities in access to health care and in health outcomes; building and maintaining a more robust health care workforce; and strengthening the resiliency of our health care system to respond to pandemics and other public health emergencies and disasters.
References
ANA Board of Directors September 2020 www.NursingWorld.org/COVID19Vaccines/
Annals of Internal Medicine https://doi.org/10.7326/M20-0751
Centers for Disease Control and Prevention. (2020). Daily updates of totals by week and state. Retrieved June 2, 2020 from, https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
Vahedian-Azimi, A., Hajiesmaeili, M., Kangasniemi, M., Fornes-Vives, J., Hunsucker, R. L., Rahimibashar, F., … Miller, A. C. (2017). Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study. Journal of Intensive Care Medicine, 34(4), 311–322. doi: 10.1177/0885066617696853
If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?
These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.
In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.
To Prepare:
Review the Resources and select one current national healthcare issue/stressor to focus on.
Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.
By Day 3 of Week 1
Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.
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By Day 6 of Week 1
Respond to at least two of your colleagues on two different days who chose a different national
healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.
Nurses play an integral role in the health care system. They provide acute care for patients in emergency rooms and intensive care units and administer medicine and other daily essentials throughout our country’s hospitals. But far too often, nurses are overworked and under-supported as hospital administrators seek to lower costs and boost profits.
In the face of aggressive cost-cutting, minimum staffing levels are necessary to ensure the safety of patients and nurses. Adequate nurse staffing is key to improving patient care and nurse retention, while poor staffing endangers patients and drives nurses from the profession. Unfortunately, staffing problems are only set to get worse as baby boomers age and the demand for health care services grows, making staffing a growing concern for nurses and patients alike.
Safe Staffing Practices Improve Patient Care Outcomes
In 1999, California became the first state to pass a law setting a legal maximum patient-to-nurse staffing ratio in order to improve patient care. Since it was fully implemented in 2004, research specific to California has shown measurably improved patient outcomes, in line with the broader academic consensus about the positive impact of lowering nurse workloads.
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The most comprehensive study of the impact of the law came out in 2010 and compared hospitals in California to hospitals in New Jersey and Pennsylvania. Researchers found significantly better health outcomes in California, including lower surgical mortality rates, reduced inpatient deaths within 30 days of admission and a lower likelihood of death from failing to properly respond to symptoms.[1]
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These conclusions are backed up by a 2018 meta-analysis of other research, which found for every increase of one nurse, patients had a 14 percent decrease in risk for inhospital mortality.[2] An earlier analysis produced similar results, showing in 2007 that an increase of one full-time registered nurse in a unit per day would result in nine percent fewer hospital-related deaths in the ICU, 16 percent fewer deaths for surgical patients and six percent fewer deaths for medical patients.[3]
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In long-term care facilities, patients with more direct RN time (30 to 40 minutes daily per patient) reported fewer pressure ulcers, acute care hospitalizations, urinary tract infections, urinary catheters, and less deterioration in their ability to perform daily living activities.[4]
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While increased nurse staffing greatly improves patient outcomes in hospitals with positive nurse working conditions, it has little to no effect in hospitals that otherwise have poor nurse working conditions. Good nursing work environments are characterized by positive working relationships between doctors and nurses, active nurse involvement in hospital decision making, management responding to nurse patient care concerns, continuing education programs for nurses and constant quality improvement for patient care programs.[5]
Inadequate Staffing Endangers Nurses and Patients Alike
The Bureau of Labor Statistics estimates that demand for registered nurses will increase 15 percent between 2016 and 2026, and 438,000 new nursing jobs will be created over this ten-year period.[6] This increase in demand only stands to compound the existing nursing shortage and other hospital staffing problems, described by the American Nurses Association (ANA):
I too discussed nursing shortages as a healthcare issue. It was interesting to read your views and research on the topic. My initial reaction to nursing shortages was to target the work environment and compensation issues that nurses face which lead to shortages. However, when I dug a bit deeper into researching about this; my eyes were opened to an entire world of reasons why there are shortages. “It is critical to include the systematic issues in education, health delivery systems and the work environment. Further, the impact of reimbursement, legislation, regulation and technological advances must also be considered. Failure to consider the relationships among these aspects limits the full appreciation of the nursing workforce shortage complexity.” (aacnnursing.org, 2022) Shortages are prevalent in the media amongst bedside nurses but extends to all specialties of practice. I was astounded at how much of a faculty shortage there is as well. How does an aspiring nurse achieve success in the first step of their career without the proper educators and resources? Let’s not forget the mounting stress of how these shortages will impact them upon entering the field as graduate nurses. “The shortage has pros and cons for nursing students. One pro is being able to find a job quickly after graduation. A key disadvantage, though, is that nursing programs have fewer openings. For students, this means acceptance into a program may be more challenging.” (nursejournal.org,2022) The issue with the pro here is that graduate nurses will have astronomical ratios, which is unsafe for all involved. Nurses, even of novice status should not have 6-7 patients on a progressive care unit, or 4 ICU patients. Patients come first. That’s what we are taught and that’s how it should stay, but what if a system is put into effect where both patients and providers are #1. Also, these nursing shortages drop patients to last on the list of priorities. That’s another discussion completely.
American Association of Colleges of Nursing: The Voice of Academic Nursing. (n.d.). Retrieved September 1, 2022, from https://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Reverse-Shortage
Writers, S. (2022, August 29). Post-pandemic nursing shortage: What it means for aspiring nurses. NurseJournal. Retrieved September 1, 2022, from https://nursejournal.org/articles/post-pandemic-nursing-shortage/
NURS 6053 Week 1 Discussion Review of Current Healthcare Issues
NURS 6053 Week 1 Discussion Review of Current Healthcare Issues
The perennial nursing shortage is a national healthcare issue of concern. Statistics at national and international levels show that the shortage of healthcare worker (HCWs) is profound and affects effective and quality service delivery. The World Health Organization (WHO) projects that the nursing shortage could hit 12.9 million by 2035 (Marc et al., 2018). Nursing shortage creates unsafe working environment and increases fatigue, high turnover rates, and make nurses susceptible to medication administration errors. The ongoing COVID-19 pandemic has exacerbated the situation as the demand for healthcare services has increased, leading to more strain and burden on nurses, especially those working in critical care settings and others with elderly patient populations with chronic and terminal conditions.
Nursing shortage has impacted my work setting negatively as we enhance efforts to provide care to a patient diversity coming to the facility. Low staff retention, reduced levels of patient’s satisfaction, and a rise in hospital acquired infections are some of the negative effects of nursing shortage in our facility. When patient workload exceeds the available shift nurses, patients experience low levels of satisfaction. Unsafe staffing ratios contribute to burnout and high turnover rates (Alenezi et al., 2018). Further, increased length of stay happens due to higher nurse-to-patient ratios lead to more complications and a rise of hospital acquired infections.
Many healthcare settings are struggling in responding to nursing shortage because of the few options available (Marshall & Broome, 2017). Our facility is now leveraging technologies like telehealth to enhance access and quality for patients with chronic conditions like diabetes and hypertension who require constant monitoring. While studies show that nursing supply may exceed demand in the near future, using technologies and innovative models like increased training and flexibility can help organizations mitigate the adverse effects of nursing shortage.
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References
Alenezi, A. M., Aboshaiqah, A., & Baker, O. (2018). Work‐related stress among nursing staff
working in government hospitals and primary health care centers. International Journal of Nursing Practice, 24(5). https://doi.org/10.1111/ijn.12676
Marc, M., Bartosiewicz, A., Burzynska, J., Chmiel, Z., & Januszewicz, P. (2018). A
nursing shortage – a prospect of global and local policies. International Nursing Review, 66(1), 9-16. https://doi.org/10.1111/inr.12473.
Marshall, E. S., & Broome, M. E. (2017). Transformational leadership in nursing: From expert
clinician to influential leader (2nd ed.). New York, NY: Springer
Nurses work in different settings with varying work demands, support mechanisms, and approaches to work. Regardless of these differences, healthcare stressors are part of everyday work. These stressors are usually workplace challenges widespread in the United States that hamper nurses’ ability to deliver timely and effective care (Rose et al., 2021). The nursing shortage is a prevalent national stressor with far-reaching effects on patient care. It is characterized by higher demand for nurses than the current supply.
The effects of the nursing shortage witnessed in other organizations may be experienced in my work setting. As Shah et al. (2021) explained, the nursing shortage is a leading cause of burnout among nurses. It increases the nurse-patient ratio implying that nurses are overworked and may lack time for self-care and other activities that enhance commitment to work. Shah et al. (2021) further observed that nurses experiencing burnout are more likely to commit medical errors than nurses working within the standard nurse-patient ratios. Errors risk patient safety and damage patients’ trust in healthcare providers. Burnout triggers turnover and increases an organization’s management costs since replacing nurses is costly.
To avert the damaging effects of the nursing shortage, healthcare organizations should implement robust strategies, both staff-centered and organization-wide. My healthcare setting has responded to the nursing shortage through continuous supervision of staff, motivation programs, and formulating policies that prevent work overload. As Lee and Lee (2022) noted, nurse motivation is critical to creating a positive work atmosphere and retaining nurses. The same perspective guides the management when developing and implementing motivation programs. Regarding the changes that may have been implemented, nurses need mental strength to cope with the increasing workload. As a result, the management should invest more in coping programs and organize appropriate training initiatives to improve nurses’ resilience.
References
Lee, J. Y., & Lee, M. H. (2022). Structural model of retention intention of nurses in small-and medium-sized hospitals: Based on Herzberg’s Motivation-Hygiene theory. Healthcare, 10(3), 502. https://doi.org/10.3390/healthcare10030502
Rose, S., Hartnett, J., & Pillai, S. (2021). Healthcare worker’s emotions, perceived stressors and coping mechanisms during the COVID-19 pandemic. PLoS One, 16(7), e0254252. https://doi.org/10.1371/journal.pone.0254252
Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469-e2036469. doi:10.1001/jamanetworkopen.2020.36469
You have shared an interesting topic. It is unfortunate that physicians are unable to provide high quality care, contributing to cadre delay and increased wait times. The need for physicians and other medical services has been on increased demand as people are living longer and chronic diseases are more prevalent (Auerbach et al., 2018). It is also unfortunate that the training times are longer, making it longer for physicians to complete their education and training (Auerbach et al., 2018). Poghosyan et al. (2018) share that by 2025, there will need to be 52,000 medical doctors to meet the demand just in primary care alone. Veterans also need medical care due to the post traumatic stress that some experience and other mental issues or coping issues to life in general.
You made a good point regarding nurse practitioners being helpful. Norful et al. (2018) share how comanagement between medical doctors and nurse practitioners will combat staffing shortages by having both of them share responsibilities and handle tasks, such as refills on medications, educating the patient, and disease management. It helps with cohesion and will help the patients receive the care that they need in a timely manner.
Thank you for sharing.
References
Auerbach, D. I., Staiger, D.O., & Buerhaus, P.I. (2018). Growing ranks of advanced practice clinicians – Implications for the physician workforce. New England Journal of Medicine, 378(25), 2358-2360.
Norful, A.A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner-physician comanagement: A theoretical model to alleviate primary care strain. Annals of Family Medicine, 16(3), 250-256.
Poghosyan, L., Norful, A., & Laugesen, M. (2018). Removing restrictions on nurse practitioners’ scope of practice in New York state: Physicians’ and nurse practitioners’ perspectives. Journal of the American Association of Nurse Practitioners, 30(6), 354-360.
A national healthcare issue/stressor that I have selected for analysis is the nursing shortage. Having a workforce that is aging, stressful environments to work in, and changes in healthcare are many reasons for nursing shortages (Ullmann et al., 2016). There are, unfortunately, negative effects of nursing shortages, such as higher nurse-patient ratios and heavy patient loads. According to Broome & Marshall (2021), workers experience information overload while multitasking which leads to errors. We are all well aware that nurse-patient ratios make it more difficult to manage patient loads and that the more the patient loads, the harder it is to properly care for patients, which unfortunately leads to increased risks of mortality, longer hospitalizations, medication errors, and other things. According to Broome & Marshall (2021), nurse turnovers are common and during the first year of their job, 20% of nurses resign.
This issue has had an impact on my work setting in the medical-surgical setting. It has led to patients not getting the timely care that they need, units and floors being closed due to not having enough staff, and patients being upset about having to wait for treatments and/or medications. It has also led to the hospital having to divert and not be able to take care of patients in the emergency room and being directed to other nearby facilities. Additionally, seasoned nurses have become frustrated and overwhelmed and quit, leading to less experienced nurses being hired, affecting the quality of care that the patients receive. According to Ullman et al. (2006), a survey revealed that nursing shortages lead to poor patient satisfaction in 25% of hospitals, emergency rooms being overcrowded, increased incidents reported in 20% of cases, and units being closed. Therefore, it is obvious that the social determinant most affected by this issue is health quality.
Though I am a travel nurse, my PRN job that I have secured since 2019 in the city where I reside has attempted to make some changes to the nurse shortages. According to Jacobs et al. (2018), helping employees to have a better sense of well-being and be more satisfied at work does help to improve things, such as a positive patient experience and less staff burnout. There are some floors at my hospital that did a trial run of having fewer patients, such as five patients to one nurse. They have also provided nurses with the opportunity to have bonus pay on a one, two, or three-month contract where they work one more day in addition to the three days they already work. They get paid more money an hour and receive a bonus check, such as $500 or $1,000. There have been some cases where some floors have provided more pay an hour. In my float pool role, I have received about a $ 2-an-hour raise for my years of experience. These were all attempts to retain nurses due to the fact that many nurses were overwhelmed and burned out and left to go traveling as a nurse. Unfortunately, some of the floors that I have floated to have made no changes other than to bring traveler nurses in to fill the vacancies. However, there is still a shifting of patients at times to other floors due to the shortage.
The facility where I presently work as a travel nurse on my assignment has only made one change, which was to bring in traveler nurses like myself. The staff has not seen any other changes made and has complained about some of the full-time staff, particularly charge nurses (who do not have patients) prefer to sit down at the nurse’s station and not help other nurses who are inundated with heavy workloads.
References
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being: Moving from the Triple Aim to the Quadruple AimLinks to an external site.Links to an external site.. Nursing Administration Quarterly, 42(3), 231–245.
Ullmann, S. G., Martin, P., Kelly, C., & Homer, J. (2006). Strategic giving and the nursing shortage. International Journal of Nonprofit & Voluntary Sector Marketing, 11(1), 3–11. https://doi.org/10.1002/nvsm.37
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