Sample Essay On Nursing

Shortage and Turnover in RN Positions and Mortality Rate

Introduction
It has been established through vast research that there is a direct and causal connection between shortage and turnover in RN positions and patient mortality rates. In fact the two sets of phenomenon are inversely proportional so that a decrease in the former leads to an increase in the latter. It was estimated that by 2012 there was an estimated shortage of more than 60,000 RNs (Juraschek et al, 2012). To respond to this it has been suggested that there be a devised a model mixing alternative skills. Most institutions are encouraged to incorporate enrolled nurses and assistants (both in nursing and healthcare) to supplement the Registered Nurses population (The American Nurses Association, 2015). This is said to have an impact on the financial implications of hiring more or exclusively Registered Nurses while at the same time increasing the number of health caregivers.
It has also however been empirically established that there is marked difference between the quality of care given by the RNs when compared to the alternative health care givers mentioned above (Bureau of Labor and Statistics, 2014). It therefore becomes a delicate balance between quality and quantity healthcare. The organization of the paper will be so that it preliminarily looks at the factors that have led to nurse shortages and RN turnover. This is then followed by an analysis of the empirical relationship between patient mortality and nurse uptake as has been scholarly determined. The resolution strategies will then follow.

Factors leading to Nurse shortages and low RN Turnover

It has been argued that some of the key contributing factors of the shortages in focus include squeezed classrooms and lecture halls. The shortage in learning infrastructure has to be balanced with the need to take up more trainees but end up with less quality graduates dureto the inadequate facilities. From a legal aspect there is similarly the balance of trying not to discriminate against some applicants by locking them out and ensuring the highest standard and quality education for those who can actually fit into the limited spaces. There are also constrains in the educational budgetary allocations, clinical sites, insufficient faculty among other things (American Association of Critical-Care Nurses, 2013). Budgetary under-allocation may occur at the federal, state or institutional level with these failing to properly prioritize and plan. This has led to qualified and suitable applicants seeking to pursue nursing courses being turned away in their tens of thousands annually. As a response the over 70,000 persons were majorly given the reason that there was no faculty space and this was the reason their applications were not successful ( American Association of Critical-Care Nurses, 2013).
Another key factor leading to the shortage is the shortage of trainers required to instruct the learners (Southern Regional Board of Education, 2009). It is only logical to assert that where the uptake of trainees is wanting or in deficit, the number of persons who qualify at the end of the courses and proceed to become lecturers and tutors will also have a shortage. The shortage of trainees has been attributed to nurse shortage but it must be acknowledges that the shortage in nurses has also led to the shortage in trainees. The shortage of trainers has also been caused by their resignation which may be directly linked to frustrations of being overworked (due to the shortages) among other things (Lindbloom, 2010).
Resignations are related to retirement of both trainers and actively practicing nurses. It has been estimated by research that the fifty five per cent (55%) of the RN population is aged fifty years and above (Budden et al, 2009). Estimates indicate that persons in surplus of one million of the population of the RN workforce are due to exit the profession and health sector in the next ten to fifteen years (Federal Division of Nursing, 2008). The report also indicated that the average age of nurses throughout the country had risen and that the trend was bound to continue.
Closely related to the age of the majority of nurses is that most were trained at a time when the technological situation was radically different from what exists now. This means that newly trained nurses may be more technology savvy and oriented when compared to their older counterparts. The efficiency of either group is affected by this gap and may have a bearing on service delivery and incidentally patient mortality. It is recommended that nurses undergo continuous training throughout their active practice to keep them at par with emerging nursing trends
The number of persons requiring nursing care is pegged to increase fundamentally in the coming years. This is especially the aged population which will require mostly exclusive care (Centers for Disease Control and Prevention, 2015). Unless the population of nurses and related caregivers is increased in proportion to the rising need there is an impending crisis and this will lead to a breakdown in the national healthcare system. There is also a massive exodus of professionals from the profession. The most probable cause f this is being overworked (due to understaffing) and underpayment. There are frustrations and non-satisfaction leading to the exits either through early retirement or resignations (McHugh et al, 2011).

Empirical relationship between patient mortality and nurse staffing

Studies have established that fewer deaths in hospitals were directly as a result of higher staffing of nurses (Blegden et al, 2011). The other advantages highlighted in the study were patients staying shorter periods in hospital as well as lower infection rates for patients in hospital.
Needleman and his colleagues also advance the same argument and find that patients’ risk of death was higher by six percent (6%) averagely in understaffed institutions than in their adequately staffed counterparts (Fischer, 2014). This data was synthesized and drawn studying records of close to 200,000 patients from 43 medical care centers across the country. It concluded that a high turnover of patients leads to an increased mortality risk. Simply put there should be enough nurses to handle the maximum patient influx in an institution at any given time. This will lead to patient mortality being attributed to things other than nurse understaffing.
In yet another related discourse it was established that a high ratio of nurses in relation to patients within surgical and medical units impacted significantly on the mortality ratios of patients (Aiken et al, 2010).
Qualification of nurses also plays a major in patient mortality seeing that out of every 1000 patients being treated in the Intensive Care Unit, there was a survival rate of about 4.9 persons who would otherwise have died. The survival rate was attributed to staffing of more nurses with Bachelor’s Degrees in the institutions (Vand den Heede, 2009). As earlier pointed out understaffing has led to increased workload which in turn reduces the quality of work or care rendered by the nurses. The net effect of this is to compromise the safety of patients (Royal College of Nursing, 2010). In addition to the established connection between number of nurses and patient mortality, the immediate connecting factors relating to the shortage and leading to loss of lives include;

Nurses Lacking time

The number of patients assigned to each nurse will definitely affect the amount of dedicated health care time for each patient. More time means more care and more improvement rates while neglect means a slower rate of recovery and even mortality. There is great bearing on the caregivers decisions on what he should and what he shouldn’t do and how to prioritize when he has many patients under his care. This difficulty to prioritize may lead to confusion lowering the net quality of care. There may also be poor communication between the nurse and patients and the one handling more patients is more likely to forget the needs of a patient he handled earlier in his shift.

Nurses’ workload

Understaffing is the key cause of high workload which in turn leads to dissatisfaction. These factors lead to regular absenteeism and there emerges situations where some patients are not cared for at all for days. The understaffing and absenteeism compound each other contributing further to patient mortality. Dissatisfaction at work also leads to organizational and institutional breakdown with the employee and employer being in constant conflict.

Errors by nurses

An increased workload can have an influence on the number of errors occurring in the workstations. There are certain tasks in the health care institutions that require devotion and attention and concentration tends to wane with stresses and fatigue. Considering the nature of work the most of the dangers the patients are exposed to are potentially fatal. A nurse giving a patient double the dose of say intravenous injection may be fatal to a critically ill patient.

Rules and Regulations violations

In any given institution there are set rules and regulations that ensure their smooth running. In hospitals and other health care institutions these include rules governing or ordering the interaction between nurses and patients. Now, nurses who are dissatisfied and overworked tend to be errant and may defy these rules (Virginia Department of Health, 2015). The net result of these violations is that the patients don’t get complete value for the time they spend in the institutions. The less motivated nurse justifies the breaking of the rules with the conditions they are provided for at work.

Resolution strategies

One of the key strategies being applied vastly by nursing schools throughout the country is to form strategic partnerships with other related institutions and bodies. This is done on a bid to incorporate private stakeholders in the nursing sector and expand on the capacity of the individual student. This is perhaps in acknowledgment that the federal government of the states alone cannot sufficiently cater for the current and ever growing needs of the health sector and especially as regards nursing (Academy Health, 2014). The partnerships are imperative in the areas of financing which helps in the purchase of the requisite training equipment as well as construction of infrastructure to solve the problems mentioned earlier. The interaction of the various institutions is also aimed at inter-professional interaction of for instance doctors and nurses, rescue workers, fire fighters and so forth. One such partnership includes the collaboration between the Academy Health and the National Center for Health Statistics.
About 4 years ago 47 state leaders gathered in Baltimore and resolved that there was need to realign the allocation of resources, come up with better policy plans, enhance faculty capacity and variety and finally to redesign the academic curricula. The key discussion under the resource allocation head was that more funds should be assigned to nursing and healthcare generally than what is currently happening (American Association of College Nursing, 2013). This actually indicated and indeed proved that there was a nationwide crisis in terms of monetary allocations to nurse training facilities. It was a further recognition that patient mortality could be reduced by a considerable amount by enhancing the training of nurses and increasing their numbers.
It has also been seen that making the work environment more comfortable for the individual and applying technological tools to train the nurses are some of the surest way to ensure nurse uptake which in turn leads to lower patient mortality. The former involves preparing the nurse for an employment setting and preparing him/her to cope and not merely training him/her on the medical and healthcare aspects of the course. The latter on the other hand involves use of non-conventional or traditional teaching methods and this is aimed at coping with a heavier work load.
Making the roles of nurses more flexible is also key in ensuring maximum utility of these professions (Pricewaterhouse Coopers’ Health Research Institute, 2007). This suggests that a single individual may be trained and become competent in various areas of the profession and this means that he/she can apply these competencies where most need lies. He/she does not have to stick only to one area of specializing. As discussed in the introductory part, the use of health care givers other than the RNs to perform their duties may also be seen as role flexibility initiatives. Despite varied capacities and competencies it is sound to acknowledge that a health caregiver available to a patient when need arises, (despite the qualifications) is better than none at all. The study also encourages partnerships between the public and private sectors to encourage and enhance nurse training and uptake which in turn reduce patient mortality.

References

American Association of Critical-Care Nurses, (2013) Report on the Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing.
Bureau of Labor and Statistics, (2014) Occupational Outlook Handbook, Retrieved from http://www.bls.gov/oco/. on 10th March, 2015
Centers for Disease Control and Prevention, (2015) Nursing Home Care, Retrieved from http://www.cdc.gov/nchs/fastats/nursing-home-care.htm. on 10th March, 2015
Federal Division of Nursing (2008) National Sample Survey of Registered Nurses, Retrieved from http://www.aacn.nche.edu/media-relations/NrsgShortageFS.pdf, on 10th March, 2015
Jack Needleman, Peter I. Buerhaus, Catherine Vanderboom and Marcelline Harris (2011) Using Present-on-Admission Coding to Improve Exclusion Rules for Quality Metrics: The Case of Failure-to-Rescue. New England Medical Journal
Jill S. Budden, et al (2009) Highlights of the National Workforce Survey of Registered Nurses
Kristen Fischer (2014) Nurses: Understaffed and Overworked on the Front Lines
Matthew D. McHugh, Ann Kutney-Lee, Jeannie P. Cimiotti (2011) Nurses’ Widespread Job Dissatisfaction, Burnout, And Frustration With Health Benefits Signal Problems For Patient Care
Rachel Lindbloom (2010) Registered Nurse Shortages Predicted in the US and Kansas for 2010 and 2020
Koen Van den Heede (2009) Nurse Staffing and Patient outcomes in Belgian Acute Hospitals: Cross-sectional Analysis of Administrative Data.
Linda Aiken et al (2014) Association of Nurse Staffing and Education with Hospital Mortality in 9 European Countries.
Mary Blegden et al (2011) Medical Care, University of California Medical Journal
Royal College of Nursing (2010) Patient Safety and Human Factors, Retrieved from http://www.rcn.org.uk/development/practice/patient_safety, On 10th March, 2015
Southern Regional Board of Education, (2009) Overcoming Doubts about Online Learning, Retrieved from http://publications.sreb.org/2009/09T02_Overcoming_Doubts.pdf, on 10th March, 2015
Stephen, J., Xiaoming, Z., Vernon, L. (2013) “United States Registered Nurses Workforce Report Card and Shortage Forecast” American Health Journal.
The American Nurses Association, (2013) The U.S Nursing Workforce: Trends in Supply and Education, Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-workforce. On 10th March, 2015
American Association of College Nursing, (2013), Mortality and Nursing Care, Retrieved from www.aacn.nche.edu/media-relations/partnerships-grants. On 11th March 2015.
Academy Health, (2014), Best Practices in Nursing Care, Retrieved from www.academyhealth.org/nchs on 11th March 2015.
Pricewaterhouse Coopers Health Research Institute, (2007) What Works: Healing the Healthcare Staffing Shortage, Retrieved from http://www.pwc.com/us/en/healthcare/publications/
what-works-healing-the-healthcare-staffing-shortage.jhtml on 11th March 2015.
Virginia Department of Health (2015) Laws Regulations and Guidelines, Retrieved from http://www.vdh.virginia.gov/OLC/laws/ on 10th March 2015.