- Research indicates that low nurse staffing levels tend to cause increased rates of poor patient outcomes within hospitals/nursing facilities. This is because it leads to increased workload which is the main source of poor quality care within a hospital environment.
- Low nurse staffing is likely to result to exhaustion, stress, deprivation of sleep, organizational culture, shift work, all of which have a negative impact to the safety of the patients. The few qualified nurses who are available in the long term care institutions have very little time and energy to provide appropriate health care (Lucy, 2001).
- Moreover, medication errors can also be brought about by poor decision making which mostly influences the goals of the health facility policies, resource allocation as well as the nursing procedures (Benner, 2011). In a recent research I undertook in the Golden Cross HealthCare which is a Skilled Nursing Facility located in N. Fair Oaks Drive of historical Pasadena California, I found out that the facility is currently housing about 91 residents. In this facility, the staffing rate for 82 residents is one Registered Nurse, two Licensed Vocational Nurses and seven Certified Nursing Assistants, an administrator and a DON (Director of Nursing), Social Service, MDS Nurse, admission nurse, staff developer.
- Reinforcement of the Nursing Educational Training
- A recent report that addressed the strategies which should be employed to curb the current nursing predicament, by the Joint Commission on the Accreditation of Healthcare Organizations recommended the reinforcement of the nursing educational system through group training in teaching nursing, boosting support in nursing orientation, offering in-service education in hospitals as well as the formulation of nursing career ladders with regards to the experiences of the nurses and their level of education (MarCarthy, 2009).
- In addition, hospital managements should provide the nurses with supplementary trainings associated with their careers, internship and mentor programs or even offer career ladder programs for career development.
- The commission also proposed that every hospital should assume the features of “magnet hospitals,” which include establishment of staffing levels with regards to the proficiency of the nurses and skill mix in relation to patient mix and perspicacity.
- The government should provide programs that facilitate the hospital staffs to upgrade their skills.
- The government should fund hospitals accordingly in order for them to implement computerization which can assist them to enroll for e-learning to upgrade their skills.
- In addition employees who work in hospitals should be given paid learning vacations to help them get an ample time to further their studies.
Improving the Staffing Ratio
- Research findings indicate that the minimal nurse staffing ratios that should be adopted either in a hospital or within the long term care institutions should be 1: 3 for the nursing assistants while that of the registered nurses, LPNs and Certified Medication Assistants is 1:6. This is an indication that most health care institutions are usually understaffed as they hardly meet this requirement.
- For this reason, in order to achieve more precise and constant measures of perspicacity and high quality patient care, all types of nursing personnel should be increased accordingly. This is because the level of nurse staffing has a direct impact on the quality of care.
- These findings can therefore be used to inform and enlighten all the parties involved on how to improve the quality of care and how it is associated to the support given by the nurses. Failure to improve nurse staffing in low staffed long term care institutions and hospitals is likely to cause suffering to a large number of patients/ residents who may experience unnecessary adverse outcomes and may also incur avertable higher costs. For this reason governments should ensure that hospitals have got enough qualified nurses in order to reduce the number of medication errors as well as falls within these institutions.
Motivation of Workforce
- The Joint Commission on the Accreditation of Healthcare Organizations also endorsed the establishment of monetary motivation to the staff in every healthcare institution. The administrators should also put appropriate measures which are meant to enhance the enrollment and maintenance of nurses.
- In addition, governments can opt to offer scholarships or low interest loans to the nursing students who agree to serve in hospitals with major shortages of nurses for a given period of time.
- Moreover, it can also pardon some loans for nurse students who go for advanced degrees.
Ways To motivate Workforce
- The government should enact policies that support the employees in the hospitals as well as other nursing hospitals to be paid handsomely.
- In addition, the policies enacted should make sure that the employees who work overtime are rewarded appropriately to motivate them
- The government should make sure that all hospitals have adequate workforce to avoid overworking the employees.
- Hospital Employees should be issued with certificate of merits as well as trophies for work well done
Controlling the Deployment of Nurses
- Deployment of nurses should also be controlled within the health as well as nursing institutions. This is because it has been noted to be major threats to patients’ safety as it depresses the nurses.
- In its most recent report on patient safety, produced in the form of a draft, the Institute of Medicine established that the deployment of nurses has greatly contributed to several momentous threats to patient safety (Resar, 2006).
- It therefore proposed measures which included the concern of direct-care nursing staff in determining and assessing the approaches used to determine appropriate unit staffing levels for each shift.
Developing a Policy Response
- policies should consider the culture as well as the management style of the long term care setting as a predictor of job fulfillment and returns.
- In these policies, administrators should take responsibility for change of culture. These policies should ensure a favorable working environment that persuades, motivates and preserves a high quality workforce.
- The policies should encompass long term care providers such as day-care centers, assisted living amenities, home care organizations as well as nursing homes.
- In the formulation of these polices, governments should play the greatest role in ensuring the implementation of these policies. This is mainly because it has the capability to finance the implementation of these policies.
- For instance, In the United States of America, through Medicare and Medicaid, the state and federal governments contribute about 60 percent of the long term care bill.
- There exists a significant relationship between lower levels of nurse staffing and higher rates of medication errors as well as falls among many other issues that may contribute to increased mortality rates.
- Nevertheless, researchers argue that, currently, such undesirable outcomes related to nursing should be seen more as pointers or lookout effects than as measures of the effect of nurse staffing on patient outcomes. Most importantly, nurses should realize that they have an enormous task of identifying and curbing the hazards that exist in their profession, with the aim of enhancing patients’ safety.
- The administrators in these institutions should assign various responsibilities to various individuals, ensure superb organizational frameworks, provide career training, and provide models that assist in the detection and upholding of a nursing safety patient tradition in order to ensure fundamental transformation within the nursing profession. Moreover, administrators should provide structures that can both be used to differentiate the risks involved and also provide efficient and sufficient guidelines to the nursing practice. In addition, motivation, controlling deployment and career training can also be used to alleviate some nursing errors and thus enhance patient safety. Policymakers should closely monitor the progress in nurse staffing issues with the aim of determining the necessary additional legislative amendments that are required to raise the level of nursing supply and thus reduce medication errors and falls to enhance the patients’ wellbeing.
- The local state and federal governments share the responsibility for licensing and regulating long term care providers and also guarantee the value of care for the residents/patients. These policies are essential in controlling work requirements as well as training prospects particularly for the poorly paid workers. For instance, governments may opt to formulate polices which establish the minimum nurse staffing ratios within any health institution. However, this should be done in a sensible manner that takes care of other personnel, including unlicensed caregivers, housekeepers, among other support staff. Besides, hospitals should raise their nurse staffing ratios across all units. Nonetheless, a recent study established that the staffing of registered nurses does not considerably reduce a hospital’s turnover, although it may heighten the hospital’s operating costs (Lundy, 2009).
- On the other hand, a high level of nurse shortage within a hospital/nursing institution raises the operating expenses and also leads to lower profit margins.
Benner, P. H. K. (2011). Clinical wisdom and interventions in acute and critical care. A thinking-in-action approach. (2nd ed.). New York: Springer Publishing Company.
Lucy, C. &. (2001). Contemporary challenges facing nurses; a look at nursing homes in the United States. New York: County Press.
Lundy, K. S. (2009). Community health nursing : caring for the public’s health. Sudbury, Mass: Jones and Bartlett Publishers.
MarCarthy, M. (2009). Hospital Administration and its Challenges. Nursing Journal, 46 , 15-32.
Resar, R. S. (2006). A trigger tool to identify adverse events in the intensive care unit. Joint Commission Journal on Quality and Patient Safety, 32(10) , 585–590.