Main Discussion Post- Week 1
Nurse staffing is a national healthcare stressor that impacts the health care system. Safe nurse staffing is essential to both the nursing profession and the overall health care system as it ensures nurses deliver safe, quality care in all practice settings (ANA, n.d.). Proper nurse staffing helps improve outcomes in several areas, including patient satisfaction, procedural and medication errors, patient mortality, hospital readmissions, and length of stay (ENA, 2018). Facilities need to develop a multi-faceted nurse staffing plan that should decrease cost without compromising patient safety, patient satisfaction, or staff satisfaction (ENA, 2018). Finding the correct balance between patients’ needs and the number of nurses to have on shift at a specific time is essential for facilities to be profitable and ensure both patient and employee satisfaction (Bazazan et al., 2019; Wynendaele et al., 2019).
COVID-19 caused drastic changes in bed capacity and nursing workforce requirements worldwide, with the hospital I am currently employed being no exception (Fan et al., 2021). I am presently employed at an Alaskan for-profit hospital in the Emergency Department (ED), as one of the charge nurses. In the ED before COVID-19, the RN to patient ratio in my facility was 3:1 with stable patients and 1:1 with any critical patient, including patients with an Emergency Severity Index (ESI) of 1 or sometimes 2 depending on specific situations. Currently, the RN to patient ratio is 5:1 with the remaining 1:1 with ESI 1’s.
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Patient census in the ED has been down in the past two to three months at my organization. Nurses are forced to flex home if nurse to patient ratios drop below 3:1. Nurses who are flexed home are required to use his or her personal PTO to cover missed hours to maintain full-time or part-time status. For example, imagine it is two in the afternoon and the nurse to patient ratio in the ED is currently 2:1. A day shift nurse (7 am-7 pm) is forced to flex home and use five hours of personal PTO to pay their wages to maintain full-time status.
In addition to increasing the nurse to patient ratio, we are now required to take two 12 hour on-call shifts each month in addition to our full-time or part-time hour requirements to help cover department staffing needs. When a nurse is on-call, he or she makes four dollars an hour. This wage is not even minimum wage, yet it ruins two entire days for the nurse if they are not called into work. The on-call nurse is utilized if a nurse is flexed home and then there is an influx of patients who check-in, helps cover holes in the schedule, and covers if a nurse calls off sick.
As I understand an organization needs to be profitable to survive and thrive in the healthcare system, my current organization has increased stress related to nursing staffing. Lowering the number of ED patients cared for by emergency nurses is the single best solution to improve patient flow and minimize ED overcrowding (ENA, 2018). Patient care, nurse satisfaction, and nurse intention to leave are all impacted by nurse staffing (ENA, 2018). Hospital management needs to pursue the access and use of reliable data so that the validity and generalizability of evidence-based research can be assessed, which in turn can be converted into policy guidelines (Wynendaele et al., 2019, p. 896). Even though several charge nurses have brought evidence-based research to our leadership, my facility continues to implement these changes and is losing skilled nurses because of it.
References
American Nurses Association. (n.d.). Nurse staffing. Retrieved February 28, 2021, from
https://www.nursingworld.org/practice-policy/nurse-staffing/
Bazazan, A., Dianat, I., Bahrampour, S., Talebian, A., Zandi, H., Sharafkhaneh, A., & Maleki-Ghahfarokhi, A. (2019, May). Association of musculoskeletal disorders and workload with work schedule and job satisfaction among emergency nurses. International Emergency Nursing, 44, 8-13. http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.ienj.2019.02.004
Emergency Nurses Association. (2018). Position statement: Staffing and productivity in the Emergency Department. Retrieved February 28, 2021, from https://www.ena.org/docs/default-source/resource-library/practice-resources/position-statements/staffingandproductivityemergencydepartment
Fan, E. M. P., Nguyen, N. H. L., Ang, S. Y., Aloweni, F., Goh, H. Q. I., Quek, L. T., Ayre, T. C., Pourghaderi, A. R., Lam, S. W., & Ong, E. H. M. (2021, January). Impact of COVID-19 on acute isolation bed capacity and nursing workforce requirements: A retrospective review. Journal of Nursing Management. Retrieved February 28, 2021, from https://onlinelibrary-wiley-com.ezp.waldenulibrary.org/doi/full/10.1111/jonm.13260
Wynendaele, H., Willems, R., Tryou, J. (2019, July). Systemic review: Association between the patient-nurse ratio and nurse outcomes in acute care hospitals. Journal of Nursing Management, (27)5, 896-917. http://dx.doi.org.ezp.waldenulibrary.org/10.1111/jonm.12764
Post a description of the national healthcare issue
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