Part One – Challenges Nurses Face in Care Delivery
Nurses are a critical part of the healthcare system due to their crucial roles of providing care to patients and serving leadership roles in hospitals and other health organizations. However, being a nurse, just like any other profession, has its challenges, which call for a high level of dedication and commitment. Short staffing, long working hours, and workplace hazards are some of the common problems facing nurses today.
Appropriate nursing staffing levels are essential in delivering effective and safe care. Ensuring safety and effectiveness in nursing is a complex process that largely depends on the changing patients’ diagnosis and treatment. Therefore, having the right number of trained and competent nurses is crucial in maintaining safety and effectiveness. However, the nursing industry today is experiencing a shortage globally due to factors like the aging population that increases demand of nursing services, the aging workforce that is retiring, and high turnover rates due to factors like burnout and work life imbalance especially for female nurses (Haddad & Toney-Butler, 2018). Low nurse-to-patient ratios result in the nurses’ failure to administer medication on time, inadequately help patients to manage pain effectively, and other services like ensuring effective skin care and changing patients’ position for comfort and safety (The Royal College of Nursing, 2017). When care is compromised, most nurses suffer job dissatisfaction and depression, which can lead to mental issues like depression or decision to quit work.
Nursing shortage can be solved by establishing a minimum number of patients that a nurse can care for. This policy would work to ensure organizations hire enough number of Registered Nurses (RNs) who will be able to provide care comfortably and safely. For instance, in early 2017, the Democratic State Senator of Ohio, through the Ohio Patient Protection Act (Senate Bill 55), pushed for restrictions on the required number of patients nurses can comfortably care for (Carlson, 2017). The bill recommended a one-to-three nurse-patient ratio for pregnant patients and pediatrics. The bill also required hospitals to publicly post their adherence to the nurse-patient ratios and forbidden the implementation of forced overtime to meet staffing needs (Carlson, 2017). Such bills can be implemented to ensure organizations adequately staff nurses, thus, relieve to both nurses and patients.
Long Working Hours
Nurses in institutions that operate around the clock are commonly subjected to shift work and long working hours. Studies have linked night-shifts and shift rotation to sleep problems like long-term insomnia and excessive sleepiness (Caruso, 2014). In his work, Negative Impacts of Shiftwork and Long Work Hours, Caruso cites two studies that found a mean of sleep duration of 5.5 hours for 12-hour shift workers (2014). Sleep deprivation has been shown to trigger a wide range of cognitive declines including the ability to concentrate, reaction time, memory, and the ability to learn motor skills. Also, studies have associated lack of or inadequate sleep with bad mood, reduced communication skills, irritability, and the ability to cope with the emotional demands at work (Caruso, 2014). Further research has indicated that lack of sleep exposes nurses to cardiovascular disorders including chest pain, high blood pressure, and myocardial infarction. These effects of sleep deprivation negatively affect patient outcomes due to nurses’ failure to perform effectively. As a result, nurses are more likely to experience burnout, job dissatisfaction, and intent to quit work.
It is important to manage the issue of long working hours and related issues like fatigue and lack of sleep to ensure patients’ and nurses’ safety and the nurses’ productivity. Managers and staff nurses need to be educated on the mental and physical demands of shift work. Appreciating the significance of rest and adequate sleep would enable them to redesign the work schedules that enable nurses to frequently break during work shift to reduce the risk for fatigue and strain.
Nurses are exposed to various hazards at work each day. These hazards include infectious diseases, latex allergy, chemical and radiation exposure, assault, and dermatitis (American Sentinel University, 2017). Nurses are at risk of blood-borne pathogens including hepatitis B, tuberculosis, and HIV during needle stick injury that commonly occurs to them. Latex allergy can cause dermatitis and a severe one can lead to anaphylaxis. The American Sentinel University recommends vinyl gloves for nurses who are allergic to latex (2017). The same organization states that nurses are the most vulnerable category to workplace violence in the healthcare industry, with psychiatric and ER units having the greatest exposure to verbal threats and assault.
Protecting nurses goes beyond their hands or skin. Hospitals and health systems can ensure safety and comfort of their workforce by ensuring they have adequate and effective safety equipments to avoid unnecessary injuries and infections. Security measures can also be heightened to ensure that nurses are guarded against assaults and all sorts of threats.
Part Two – The Institute of Medicine 2010 Future Nursing Report- Key Messages
Nursing is a broad field that covers health promotion, coordination of care, prevention and cure of disease, and palliative care. Nurses perform patient assessments, evaluations, and provide care in hospitals, workplaces, schools, ambulatory settings, and nursing homes (Institute of Medicine, 2011). They strive to deliver care safely, compassionately, and effectively and extend their care to their patients’ families, often beyond physical health needs, to deliver mental, social, and spiritual needs. Due to their expansive role, training, and experience, nurses can contribute greatly towards healthcare transformation. Factors like care management and coordination, transitional care, and patient education are likely to dominate the new healthcare system, according to the Institute of Medicine (2011). Nurses play a big role in ensuring quality, value, and access of healthcare. Due to their crucial role, the Institute of Medicine suggested four strategies for transforming the nursing profession. Below is an examination of one of the strategies.
The Need to Transform Education
The second key message reinforces changes in the education of nurses before and after they receive practicing licenses. The U.S healthcare system is undergoing massive changes, which will require new and improved practices and skill. The changing healthcare environment calls upon nurses to make critical decisions regarding care for chronically ill patients and utilize complex, life-saving technologies. Nurses are required to serve as primary care givers to help patients with the management of chronic illnesses, thus, the prevention of acute pain or disease progression. Further, nurses are expected to partner with other health professionals like physicians, pharmacists, therapists, and social workers to deliver coordinated care (Institute of Medicine, 2011). Nurses today use complex technological tools and information management systems that require experience in analysis and synthesis of care.
As a result, future generations of nurses should be well placed to deliver patient-centered, safe, and quality care in all environments. There is need for nurses to attain advanced education and training. In their report, the Institute of Medicine mentions the need for achieving the goal of enrolling a greater number of nurses with a baccalaureate degree or enabling nurses to progress to this degree early in their practice (2011). Primary care providers and researchers should also be swift in advancing to the master’s and doctoral level. To facilitate progress in education, there should be opportunities that enhance seamless transition to higher degree programs including licensed practical nurse/licensed vocational nurse degrees, associate’s degree in nursing, bachelor’s degree in nursing, master’s degree in nursing, PhD, and doctor of nursing practice (Institute of Medicine, 2011). Some innovative strategies are already in use across the country to achieve the goal of education advancement in nurses. These strategies include online education, consortium programs that facilitate the progress from AND to BSN and the upper level degrees. The new education system will ensure nurses acquire the right tools to adapt to the changes in technology, science, and the demographic changes, which shape the delivery of care.
Part Three – Five Core Competencies of the Institute of Medicine
The reformed healthcare system will be dominated by competencies including patient-centeredness, quality improvement, inter-professional teams, evidence-based practice, and health information technologies.
Patient-centered care ensures that individual’s specific health needs and expectations are the driving force of all healthcare decisions and quality measurements. Nurses should ensure to provide holistic care that satisfies clinical, emotional, spiritual, mental, and social needs. Patient-centeredness leads to improved patient satisfaction, enhanced reputation of nurses, and improved morale and productivity of nurses (Institute of Medicine, 2011). However, it can be challenging to collaborate with patients because of disagreements on certain decisions.
Quality Improvement Principles
Ensuring quality improvement is essential in building a highly educated workforce. To achieve this, there is need to perform extensive evaluation and redesign the educational system to disseminate knowledge on the emerging competencies required to achieve effectiveness in the reformed healthcare system. However, it can be difficult to assess whether students have the theoretical understanding of what they have learnt and their potential to apply it in practice.
Nurses will be required to coordinate more with fellow nurses and other health professionals including physicians, social workers, and pharmacists among others to ensure effective patient care. The successful coordination, however, can be undermined by different educational systems offered to various categories of health workers, which hinders collaboration.
Evidenced-based practice requires nurses to integrate updated best clinical evidence in making decisions of care for individual patients. While this approach would yield great health outcomes, nurses may lack time for research due to workload. To effectively offer evidence-based care, nurses require to extensively explore current clinical research and to determine credible outcomes to apply. Most nurses lack the knowledge to judge the credibility of the evidence provided by the research.
Health Information Technologies
Health information technologies like Practice Management Software (PMS), EMR, and EHR improve quality and effectiveness. These technologies also reduce costs and minimize errors. Despite their great benefits, nurses may lack the skill to handle these technologies, which may compromise quality of care. Additionally, health facilities are adopting these technologies at a slower pace due to the installation costs and the training of the workforce to effectively use them. This, in turn, denies nurses the chance of advancing their practice.
Carlson, K. (2017, Nov 1). Nurse-patient ratios and safe staffing: 10 ways nurses can lead the change. Nurse.org. Retrieved from https://nurse.org/articles/nurse-patient-ratios-and-safe-staffing/
Caruso, C.C. (2014, Jan-Feb). Negative impacts of shiftwork and long work hours. Rehabilitation Nursing, 39(1), 16-25. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629843/
Haddad, L.M. & Toney-Butler, T.J. (2018, Oct 27). Nursing, shortage. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK493175/
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. The National Academies Press. Retrieved from https://www.ic4n.org/wp-content/uploads/2018/03/The-Future-of-Nursing-Report-2010.pdf
Royal College of Nursing. (2017). Safe and effective staffing: Nursing against the odds. Royal College of Nursing. Retrieved from https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2017/september/pdf-006415.pdf
The Sentinel Watch. (2017, Sep 26). Nurses face workplace hazards. The Sentinel Watch. Retrieved from https://www.americansentinel.edu/blog/2017/09/26/nurses-face-workplace-hazards/