NURS 6053 Assignment Discussion
NURS 6053 Assignment Discussion
NURS 6053 Assignment Discussion

Nurse Shortage as a Healthcare Issue or Stressor in an Organizational Setting: Competing Needs, Policy Implications, and Ethical Considerations

The healthcare issue or stressor identified earlier is nursing staff shortage in the healthcare organization. As can be surmised, this issue has far-reaching implications on the quality of care that a health institution can offer (Antwi & Bowblis, 2018). This fact derives from the simple fact that nurses are the one with direct contact to patients and therefore form the face of the organization’s service product. This paper therefore takes a look at this healthcare stressor in terms of competing organizational interest that impact it such as nurses’ need for better pay and a conducive working environment, and the patients’ need to be offered the best quality care possible by nurses who are committed to their job. NURS 6053 Assignment Discussion

In the above context, therefore, the two competing needs in the organization that directly influence this healthcare stressor (nurse shortage) are:

A need by the nurses in the organization to fulfil their financial obligations, take care of their families, and live a comfortable life. This competing need comes against the organization’s owners’ need to get a substantial return on investment (ROI) on their business.
The need by the patients to get only the best in healthcare and nursing services, since they pay for the same and are also entitled to quality healthcare. This is a direct competing need to that one of the nurses above. As the nurses feel that they are not remunerated well enough for their efforts, the patients will be seeing the demotivated nurses as professionals who are not loyal to their calling and who are not following their professional standards of practice.
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A Relevant Policy Influencing Nurse Shortage as a Healthcare Stressor

One of the organizational policies in my facility that directly influences nursing shortage is the policy of hiring only short-term contractual employees. The contractual agreement between each employee and the organization does not exceed five years. After this, if an employee wishes to continue working for the organization they have to renew their contract. There are no permanent employees in the organization who have full benefits that come with the status. This is a policy that was put in the organization’s strategic plan as a way to save on costs and spend less on human resource. The thinking was that a long-serving employee is more likely to ask for better pay than a new recruit who is fresh from college. Unfortunately, this policy only makes the experienced nurses feel that they are neither valued by the organization nor appreciated. As a result, whenever they get better offers of job security elsewhere, they do not hesitate to tender their resignations. Nurse shortage is therefore a perennial problem at the institution because of this policy (Perry et al., 2018; Cheng et al., 2016).

The policy has thus affected not only the effectiveness of healthcare service delivery, but also its quality. The ratio of nurses to patients in every given shift is one of the parameters with which quality of nursing care is assessed (Rubin, 2015). When there is a perennial shortage of nurses, there is a perennial non-compliance with the professional standards of nursing practice that outline the amount of work that a nurse can comfortably handle. With passage of time, the remaining nurses become overworked and soon start experiencing burnout. What ensues is a vicious cycle of resignations and a drop in the quality of nursing care in the organization (Wise, 2018). NURS 6053 Assignment Discussion

Ethical Critique of the Above Policy

The bioethical principles of beneficence, nonmaleficence, and justice require that all patients be handled in such a way that only good is done to them, no harm is brought to them, and fairness is exercised. With a policy that encourages and facilitates nurses to leave the organization for better employers, none of these ethical principles is respected. The low nurse numbers means that clinical tasks cannot be completed correctly and in a timely manner. Patients might thus miss their medication timings, especially those on insulin who may then even go into life-threatening metabolic crises. This is clearly a violation of beneficence and nonmaleficence. Because the patients are also denied the chance to have enough nurses to take good care of them, no justice is done to them and fairness becomes non-existent.

The only strength of the policy above in promoting ethics would be that a new employee is always eager to follow rules, regulations, and standards of practice than those that have stayed for longer. They will not take short-cuts in delivering care and will be compassionate towards the patients because they know that their work ethic is being observed. Because of this, the patients get the best care by default and benefit from this situation and this policy. The weakness, however, is that the policy actually harms the patients in the long run by way of chronic low quality nursing care. Apart from that, it also harms the nurses in that they are overworked without commensurate remuneration. This affects them physically, emotionally, and psychologically such that they may even get a mental breakdown necessitating admission to hospital. This is unethical and immoral as the needs of nurses are also important as indispensable members of the healthcare team.

Recommendations of Changes to Practice and Policy

It goes without saying that the biggest policy change that is needed in this organization to turn around the issue of nurse shortage is the recruitment and retention policy. The organization’s top management needs to meet and make immediate policy changes to the effect that nurses who have currently worked for the organization for more than three years are going to be taken as permanent employees with additional benefits. For those who are yet to finish two years, they can be given the opportunity to convert their contract to permanent employee status after the two years. This is to cushion the organization from the financial implications of the new policy. With a promise to review their remuneration in the next fiscal year, the new permanent employees can be given other immediate incentives such as on-the-job upskilling opportunities. This is where, for instance, new healthcare technological product companies are invited to train nurses who will use the said technology. NURS 6053 Assignment Discussion

To ease the acute shortage in the short term, however, temporary nurses working elsewhere can be hired when they are available on locum tenens basis (Thy et al., 2018). This will ensure that services continue normally or near normally as the organization streamlines its human resource policy. Locum is an effective stop-gap measure that has been used elsewhere to plug staff shortages.

Conclusion

Nurse shortage is a very serious healthcare stressor that, if not addressed promptly, may bring the operations of a healthcare institution to a grinding halt. This is because the state regulatory authorities such as the nursing boards may not allow for such an eventuality that endangers the safety of patients. Strategies for tackling the issue include a change in the organization’s bad policies and an implementation of new progressive ones. Ethical considerations must also always be taken into account when these policies are reviewed.

References

Antwi, Y.A. & Bowblis, J.R. (2018). The impact of nurse turnover on quality of care and mortality in nursing homes: Evidence from the great recession. American Journal of Health Economics, 4(2), 131–163. https://doi.org/10.17848/wp15-249

Cheng, C., Bartram, T., Karimi, L., & Leggat, S. (2016). Transformational leadership and social identity as predictors of team climate, perceived quality of care, burnout and turnover intention among nurses. Personnel Review, 45(6), 1200–1216. Doi:10.1108/pr-05-2015-0118

Perry, S.J., Richter, J.P. & Beauvais, B. (2018). The effects of nursing satisfaction and turnover cognitions on patient attitudes and outcomes: A three-level multisource study. Health Services Research. Doi: 10.1111/1475-6773.12997

Rubin, R. (2015). Bill takes aim at national shortage of nurses. JAMA, 313(18), 1787. doi:10.1001/jama.2015.3747

Wise, J. (2018). Hospital suspends chemotherapy because of nurse shortage. British Medical Journal, 363(k4687). Doi: 10.1136/bmj.k4687

Thy, M., Bardon, J. & Carbonne, H. (2018). Evaluation of locum tenens activity by young anaesthesiologists and intensivists: A national survey. Anaesthesia, Critical Care & Pain Medication, https://doi.org/10.1016/j.accpm.2018.04.005

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NURS 6053 Assignment Discussion