Nursing Problem: Shortage of Nurses WGU

Nursing Problem: Shortage of Nurses in Healthcare

Nursing Shortage

Researchers in Phoebe Memorial Hospital, gathered information to help them understand the extreme nursing shortage. The shortage they discovered, comes from not having an adequate amount of nurses, thus producing high turnover, potentially compromising patient safety and care. High turnover rates come from nurses themselves feeling upset and dissatisfied with long works hours and low pay. Data collected reveals, high patient-to-nurse ratios leads to high frustration levels and job burnout (Currie and Carr Hill 2012, p. 1180). At Phoebe Memorial Hosptial, inadequate staffing played a negative role in patient results. Various studies have confirmed that hospitals like Phoebe that experience high nurse turnover are the ones that have the highest rates of risk-adjusted death and severity-adjusted span of stay (CHAN et al. 2012).

While there is no definitive way of evaluating the reasons behind the nursing shortage at the Phoebe Memorial Hospital, a report may offer a potential solution to the problem. Healthcare organizations like Phoebe Memorial experience frequent demand for well-trained nurses. In the past, Phoebe Memorial Hospital has encountered nursing shortages when demand to fill such job openings was higher than the existing supply of competent nurses.

Typically, such vacancies remained unfilled for a lengthy period of time and remained that way until such positions were filled. However, because such positions took so long to fill, the nurses that worked in the hospital kept working longer hours, leading to increased stress and dissatisfaction, and ending in higher turnover rates. These higher turnover rates created a cycle of less viable nurses available for the growing amount of unfilled job positions. Both the demand and supply factors caused the apparent scarcity. Researchers at Phoebe Memorial found that experienced nurses in key specialties like intensive care and natal care are in short supply.

Change in the Workplace

On average, nurses at Phoebe Memorial Hospital work eight and a half weeks of overtime every year. Recent studies reveal on average nurses take care of too many patients, work tirelessly on a daily basis, and endure long shifts lasting twelve and sixteen-hours. "Thirty-eight percent of nurses in China had high burnout and 45% were dissatisfied with their jobs. Substantial percentages of nurses described their work environment and the quality of care on their unit as poor or fair (61% and 29%, respectively) and graded their hospital low on patient safety (36%)" (You et al. 2013, p. 154). Such strenuous conditions leads to lower quality of care, and lower patient satisfaction.

This endless and often times brutal cycle surrounds the nursing profession at Phoebe Memorial Hospital. Aside from lower nurse and patient satisfaction and higher nurse turnover rate, the nursing shortage also has significant cost effects for Phoebe Memorial Hospital. Even though estimates vary broadly, the rate of recruiting and training one new nurse for a medical-surgical floor is normally equivalent to 100% of a nurse's twelve-monthly salary -- $42,000 -- $60,000; that deal is much higher for phoebe's emergency department. Even though there has been a rise in the number of registered nurses in current years at Phoebe, most of the progression is accounted for by nurses over age fifty and foreign-born nurses.

Phoebe Memorial Hospital has been hiring temporary nurses through staffing agencies in order to put a dent in their shortages. This practice has brought up some concerns in regards to the quality and consistency from new recruits, namely the cost of training short-term staff and the care they provide. Another concern is transparent. Agency-hired nurses may not work as openly or are as communicative as Phoebe Memorial nurses and may cause tension within the nursing population and other medical staff.

While agency-hired nurses provide short-term solutions, these temporary fixes are not a viable long-term answer for Phoebe Memorial Hospital. Without careful planning and development of evidence-based practices, the nursing shortage will carry on and get worse. By 2020, researchers suggest the nursing shortage will increase to an even higher level (Toh, Ang and Devi 2012, p. 130). To avoid such a catastrophe, RWJF is focusing on core issues for nursing shortages at Phoebe Memorial to decrease nurse turnover rate, increase job satisfaction and improve the quality of patient care.

Stakeholders

Georgia's existing nursing programs alleviate some of the foreseeable shortages through proper education and training. Nevertheless, in order to address the current shortage that will inevitably fuel future shortages, Georgia needs to support educational strategies for nursing that do more than just change and improve current curriculum. The extra and necessary step involves development of curriculm and training that utilizes evidence-based practices that may lead to greater student learning, greater enrollment volume, and better-quality admission into the profession, particularly for men, racial and ethnic minorities.

Beginning in 2016, the Health Services Cost Review Commission (HSCRC) will implement the Nurse Support Program at Phoebe Memorial Hospital, intended to support initiatives that Increase student numbers in nursing education programs. The Georgia Consortium for Nursing Education (GCNE) shared a public event in 2012, where public nursing schools in Oregon came together to talk about need to address the nursing shortage problem for affected hospitals like Phoebe Memorial Hospital. They successively worked together to plan, from the ground up, a new nursing curriculum.
Full APA citation for at least 5 sources

Evidence Strength (1-7) and Evidence Hierarchy

1. Groff-Paris, L., & Terhaar, M. (2010). Using Maslow's Pyramid and the National Database of Nursing Quality Indicators™ to Attain a Healthier Work Environment. Online J Issues Nurs, 16(1), 6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21800926

Level I: Evidence from a systematic review of all relevant randomized controlled trials (RCT's), or evidence-based clinical practice guidelines based on systematic reviews of RCT's

2. Liu, M., Lam, B., Fong, P., & Yuang, H. (2012). Nursing shortage: the facts and strategies in Macao society. Online J Issues Nurs, 19(18), 1. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23452194

Level III: Evidence obtained from well-designed controlled trials without randomization, quasi-experimental

3. Raines, D. (2010). What attracts second degree students to a career in nursing?. Online J Issues Nurs, 16(1), 8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21800928

Level VII: Evidence from the opinion of authorities and/or reports of expert committees

4. Reilly, J., Fargen, J., & Walker-Daniels, K. (2011). A Public Health Nursing Shortage. AJN, American Journal Of Nursing, 111(7), 11. http://dx.doi.org/10.1097/01.naj.0000399292.51773.e3.

Level I: Evidence from a systematic review of all relevant randomized controlled trials (RCT's), or evidence-based clinical practice guidelines based on systematic reviews of RCT's

5. Rubin, R. (2015). Bill Takes Aim at Nationwide Shortage of Nurses. JAMA, 313(18), 1787. http://dx.doi.org/10.1001/jama.2015.3747

Level V: Evidence from systematic reviews of descriptive and qualitative studies

Evidence Summary Based

Insufficient staffing and daily hassles are what increase the stress level of nurses and push numerous nurses to leave the vocation (Liu, Lam, Fong & Yuang, 2012, p. 1). Disruptive behavior and verbal abuse on the part of doctors have also been linked with nurses' job displeasure. Among nurses wishing to advance their education, Reilly, Fargen & Walker-Daniels explain there is growing difficulty in applying for and completing nursing programs. "Other barriers facing students who seek to further their education include a significant outlay of time and money, personal and family issues related to these challenges, and the complexity of the application process" (Reilly, Fargen & Walker-Daniels, 2011, p. 11). Nurse leaders are advised to address first basic needs for sufficient staffing and then move on to more complex issues that require more planning and resources to execute effectively. Daily stressors are often the most crucial step to take in order to begin the process of fixing the nursing shortage. "The strongest predictor of nurse job dissatisfaction and intent to leave is that of stress in the practice environment. Good communication, control over practice, decision making at the bedside, teamwork, and nurse empowerment have been found to increase nurse satisfaction and decrease turnover" (Groff, 2012, p. 6).

day-to-day 'hassles,' such as medication administration and transfer of care during the end of shifts prevents nurses from achieving noteworthy patient care. Rita Rubin writes an article on the passing of a bill that will help set a minimum for nurse-to-patient ratios in order to decrease the workload of existing nurses. "The National Nursing Shortage Reform and Patient Advocacy Act, introduced March 25, would establish minimum registered nurse -- to-patient ratios in hospitals, protect nurses' rights to advocate on behalf of their patients, and invest in training and retraining nurses to address the nationwide shortage" (Rubin, 2015, p. 1787). Other activities meant to improve patient care and decrease workload for nurses is taking the moment to check and document medicines and materials used for each patient. These straightforward additions are able to reduce stressors and increase patient safety by removing potentially harmful errors from nursing practice and improve the nurses' insight on what medications patients are taking and what materials were used to treat them.

The practice environments or stages of necessities identified in certain studies corresponded with Maslow's structure, as well as nurses' needing to feel secure in their environment…