Shortage in Nursing and Patient Care

Abstract

More and more often, the issue of staffing has affected hospitals, nursing homes, and many other healthcare facilities. This problem has wide-ranging ramifications for patient care. As the staffing situations become worse, hospitals are forced to offer care to patients that are not as comprehensive as it once was. The low staffing availability of nurses, in particular, has been detrimental in the delivery of adequate patient care. This lack of care has led to an increasing number of patient-related mistakes, deaths and low-level care. The purpose of this paper is to examine and address the issue of low staffing in hospitals and to see how this concern is of major importance to the field of healthcare overall, and nurses in particular. Understanding the issue and its ramifications can elucidate professionals in the field regarding possible solutions to the current staffing shortages that are creating patient care standards to fall all over the country.

Shortage in Nursing and Patient Care

While observing a shift at a local hospital it was witnessed that on continuous days there was a shortage of staff in regards to nurses that could be on duty. This problem had occurred specifically two days in a row at this hospital. On these days of nurse absence due to personal illness, there was no backup nurse available that was able to cover the shift. This put the hospital in a situation in which it had no backup and therefore not enough nurses according to the observations made. The floor in question was short-staffed and unable to keep up the pace while effectively giving the proper amount of care to each patient. The stretching of the staff and the lack of care became evident in the middle of the shift when a patient was found to have developed a pressure ulcer. Generally speaking, the staff is able to catch these developments through frequent progress checks of patients, which were not conducted on the day in question due to the floor simply not having enough coverage to make this a reality.

This scenario is sadly, very common in hospitals around the country, as well as hospitals in other parts of the world. Nursing shortages have caused a great deal of concern throughout the international medical and healthcare community. With this shortage of not having a foreseeable end in sight, medical providers are forced to deal with the reality of negatively affected patient care. This lower level of patient care can range from patients being admitted more slowly, basic practices of collecting vitals being delayed, and the routine checkups on hospitalized patients being dragged out far past a level that is conducive to good patient care. These realities have not been lost on patients and their families and have led to not only dissatisfaction from the medical providers but intense dissatisfaction from patients who feel that they are not receiving the basic levels of care that they should be entitled to. The matter of shortages at hospitals are therefore important to the field of nursing since nurses are many times the main point of contact for patients inside of hospitals. Many points and angles have been explored by researchers to assess the situation and find solutions to deal with these shortcomings in patient care. The solutions to the problem can be found in the literature that assesses the extent of the issue. These solutions are meant to build on current literature, expand it and offer solutions for the present as well as paths that future research and considerations should take.

The entire issue of staffing shortages of nurses relates to the initial decision to determine that there indeed is a shortage to start with. Luckily for the academic research related to this field, it has been generally agreed upon that not only does the US have an intense shortage of nurses, but the entire world appears to be suffering from this issue (Trossman, 2002). The nursing shortage has been around for some time now and the term refers simply to the concern of there not being enough nurses to effectively handle the load of patients that are being cared for on a daily basis. The problem is quite real and has been studied by academics in relation to the perceived laxity this causes in patient care amongst nurses as well as patients (Buerhaus, Donelan, Ulrich, Norman, Williams & Dittus, 2005). As the population ages and more people have access to healthcare, there is a need to increase the number of nurses in hospitals. Despite the booming numbers of patients every year, the numbers of nurses have not kept pace in terms of growth. The problem has been made even worse with more nurses leaving the workforce than are entering it (Goodin, 2003).

Nursing schools have had a steady decline in successful graduations and academically prepared professionals to enter the field every single year (Hinshaw, 2001). The studies done into this part of the concern have even noted that the nursing schools themselves are part of the problem because they do not have sufficient levels of nursing faculty to even teach new nursing students. In fact, Hinshaw (2001) even pointed out that at the time of her study that only 50% of faculty at best was even sufficiently qualified to be teaching at nursing schools. That study suggested that within a decade the staffing problems would only worsen with the older nursing professionals graying out of the profession, leaving an even larger gap between the demand for nurses and available professionals. This prediction turned out to be true with the staffing shortages of the current times being worse than they were in the early 2000s.

The problem is clearly growing and the effects will only grow in turn. While there are many problems with nursing shortages, the main concern is that of the quality of care that is given to patients in hospitals. Research by (Buerhaus, Donelan, Ulrich, Norman, DeRoches, & Dittus, 2007) found that while the shortage was causing a multitude of problems, nurses and doctors found that safety concerns for the patient in hospitals were the most pressing matter. Their research went on to clarify this concern by highlighting the fact that catching patient complications and concerns early on was a major aggravating factor to efficient patient care. This concern can clearly be seen in the scenario of the hospital with a deficient number of nurses on the floor who did not catch the issue of the ulcer mentioned previously. Not being able to identify these minor symptoms that can be indicative of graver medical concerns in a hospital setting were jeopardizing patient safety, as well as opening up the hospital and providers to liability. Both of these concerns are important for the medical profession, hospitals, patients and administrators. Patient care is vital for the success of a hospital and the core objective of all medical health providers. Nurses, in particular, are the backbone of patient care in hospital settings and without adequate staffing are not able to effectively fulfill their duties and obligations, making this issue of the utmost importance to them. Additionally, this lack of care and attention to details will continuously bring the problem into the courtrooms where it will cause financial damage and regulations to address and fix the problem through the courts.

Current research into the problem has found that indeed there is a direct correlation to patient satisfaction and care as it relates to nursing shortages in a hospital setting. The large body of research can be broken down into many subtopics and two that came up repeatedly were the causes of the shortage and the correlation between the shortage and lacking patient care. The causes of shortage related directly to the lack of instructors to teach the courses necessary in nursing programs as researched by Hinshaw (2001). Research done by (Buerhaus, et al, 2007) pointed out that there was a significant difference in the effects that nurses and doctors felt were caused by shortages, and that these differences were vital to understanding the shortages in the first place. Some common concerns that were found in a cross-section of hospitals researched was that of job dissatisfaction and nurse burnout (Aiken, et al, 2001). Job dissatisfaction was found in an equal number of hospitals across the USA, Canada, and Western Europe. In this study 700 hospitals spread amongst multiple countries, all reported similar reasons for burnout and dissatisfaction, and it was related to management practices and work design as the primary problem concerns. The dissatisfaction spoken about in the research matched very closely with the experiences felt at local hospitals. Dissatisfaction due to management, long shift and a lack of streamlined processes were at the core of discontent amongst many nurses.

Subsequently, this dissatisfaction in the position and the daily practices of the hospital only exasperate the issue of nurses leaving the workforce, and not enough entering the workforce as a replacement (Aiken, Clarke, & Sloan, 2002). Presently it has been stated that one concern that is alarming is the possibility that fewer nurses will lead to slower nurse responses and care for patients in the hospital setting. This direct relationship was researched closely by (Aiken, et al, 2002) when 168 hospitals over the course of a year were studied through a cross-section analysis. This study found that there was a 7% increase in the risk of mortality when nurses had additional patients added to their rounds. This 7% number was an increase per additional patient, making the implication quite significant. The increased mortality was measured in relation to an increased likelihood of dying within 30 days of admission or an increase in the likelihood of failed rescues. This trend was also witnessed in the hospital setting with many conditions that could have been rectified had they been caught earlier not receiving attention until they had gotten to the point of danger. This was all due to missed phone calls, lack of proper communication, longer than normal queues for testing and results, as well as delayed patient attention, just to name a few.

The path to rectifying this concern lays in both addressing its causes and attempting to handle the problem in the here and now. The problem is both steeped in practice and policy. The best practice for the nursing field would require both to be taken care of with an equal amount of diligence. By addressing the causes, policy and effort can be made to change the methods in which the profession is discussed at the academic level to encourage growth. Research by (Hassmiller and Cozine, 2006) discussed this concern directly with work that found the need for the dissatisfaction within nursing to be addressed. They found that this research is the best hope the nursing profession has to not only bring in new nurses but also retain valuable nurses. With respect to the effects on patients directly, more streamlined processes and schedules can be implemented by floor nurses, nursing directors and shift supervisors. This would require nurses to take the initiative to create methods by which they are able to support each other and create signifiers and paperwork to assist in loads of nurses on each shift. Nurse supervisors would also benefit by assessing the specific needs of their hospital to schedule nurses in a manner that is balanced but also takes into account the nuances of the hospital's patient load and habits. Currently, nurses are trained in these areas and education related to patient care and backup plans are formulated to take the unexpected into consideration as much as possible.

Future considerations into this area of concern would do well to build upon the efforts that researchers have been making regarding addressing the causes of the shortage. This can involve looking into a newer way of encouraging entry into the field, bringing in nurses from other qualified parts of the world and addressing the concerns of current nurses to promote a healthy lifestyle and higher job satisfaction. The management and policy aspects of this can be looked into by the leadership of the nursing community as well as hospital administrators. Additionally, research should be done into financial aspects of failing to hire the proper number of nurses to adequately address patient concerns. This can be done by assessing the cost of additional nurses compared to higher insurance costs related to liability incurred by failing to treat patients efficiently.

The shortages in nursing will continue to cause problems that will only increase as more of the population ages. Thanks to modern medicine, more individuals are living longer but are combating increases in chronic disease. This, in turn, means that hospitals that are increasingly filled with patients that are in need of care that is constant and focused. Nurses are greatly outnumbered by patients and the situation is making proper and attentive care difficult to administer. If the nursing profession does not grow at some steady pace with the need for nurses, the situation will become detrimental to the providers involved as well as the patients whose lives depend on nurses in the hospital setting. Patient satisfaction and the deficiency in patient care related to this problem can be addressed with long term and structures plan to address the concern. Failing to do so will result in a problem that will only get worse over time.

References

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Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. The Journal of the American Medical Association, 287, 1987-1993.

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