Developing Organizational Policies and Practices

Competing needs arise within any organization as employees seek to meet their targets and leaders seek to meet company goals. As a leader, successful management of these goals requires establishing priorities and allocating resources accordingly.

Within a healthcare setting, the needs of the workforce, resources, and patients are often in conflict. Mandatory overtime, implementation of staffing ratios, use of unlicensed assisting personnel, and employer reductions of education benefits are examples of practices that might lead to conflicting needs in practice.

Leaders can contribute to both the problem and the solution through policies, action, and inaction. In this Assignment, you will further develop the white paper you began work on in Module 1 by addressing competing needs within your organization.

To Prepare:

• Review the national healthcare issue/stressor you examined in your Assignment for Module 1, and review the analysis of the healthcare issue/stressor you selected.
• Identify and review two evidence-based scholarly resources that focus on proposed policies/practices to apply to your selected healthcare issue/stressor.
• Reflect on the feedback you received from your colleagues on your Discussion post regarding competing needs.

The Assignment (4-5 pages):

Developing Organizational Policies and Practices

Add a section to the paper you submitted in Module 1. The new section should address the following:

• Identify and describe at least two competing needs impacting your selected healthcare issue/stressor.
• Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor.
• Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics.
• Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples.
• Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations.
• Due to the nature of this assignment, your instructor may require more than 7 days to provide you with quality feedback.

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Module 1 paper

Pertinent Healthcare Issue: Nurse Shortage

In the healthcare business, nurses perform a critical role. They account for the lion’s share of the world’s total number of healthcare workers. According to the Globe Health Organization’s World Health Statistics Report, 29 million nurses and midwives are working around the globe, with 3.9 million working in the United States (Drennan & Ross, 2019). Nonetheless, in the United States of America, a persistent nursing shortage severely hinders good health. For example, approximately 1.6 million additional nurses would be needed by the end of this year to fill the shortfall (Drennan & Ross, 2019). One of the reasons contributing to the growing need for extra nurses is that a high number of baby boomers have reached retirement age. Nurses over 55 who desire to retire or reduce their clinical work volumes account for 23% of the total (Broome & Marshall, 2020). According to predictions, around 1.1 million baby boomer nursing professionals will retire over the next two decades. Consequently, there is a persistent nursing shortage in the United States, contributing to the country’s current condition of affairs (Fraher and Brandt, 2019). The purpose of this article is to study nurse shortages in-depth, the implications for an organization, and to provide viable solutions.

The Impact of Nurse Shortage on the Organization

Throughout my organization, the nursing shortage is readily apparent. According to the American Nurses Association, approximately 50 nurses have left the field in the last five years. In addition, the facility’s nurse turnover rate exceeds 19 percent on an annual basis. The upshot of this has been a scarcity of nursing personnel. The rate of new nursing employees, on the other hand, is around 10% lower than the national average. Consequently, the nurses at the institution are dealing with an increase in workload. Nurse burnout is on the rise within the nursing sector due to a lack of qualified nurses in the country. Medical errors are a result of burnout, and these mistakes result in patient fatalities and litigation. According to one example, the institution lost almost $55,000 in the previous fiscal year in order to compensate families whose loved ones died or fell sick because of erroneously administered care. The expense of medication has also climbed in tandem with the lengthening of patient stays, which is a worrying trend. Because the patient’s health worsens because of the inconsistent medicines, the patient’s safety scores also drop. A decrease in patient safety has occurred at the institution, as shown by a reduction in the LeapFrog Patient Safety Score from a grade of C to a grade of D. Therefore, there is a compelling need to address this public health issue on a national scale throughout the country.

Article 1: Global nurse shortages: The facts, the impact, and action for change.

The goal of this study was to undertake a comprehensive examination in order to provide potential remedies to the global nursing professor shortage. To address or mitigate the shortage of nursing faculty, a meta-analysis was utilized to examine and critically evaluate the solutions given by key nursing organizations for alleviating or ameliorating the shortage of nursing faculty (Drennan and Ross, 2019). According to the authors, a scarcity of nursing professors at nursing schools throughout the world is causing a shortage of nurses in the United States and around the world.

In order to develop a plausible point of view on the issue, the authors performed a thorough review of several published resources. They searched for white papers and position statements in multiple databases using CINAHL, PubMed, and Google Scholar, among other resources. There were 62 articles that yielded 181 ideas. The responses provided in these publications were split into eight major categories (Drennan and Ross, 2019). These included more significant funding for nursing faculty positions in nursing schools, worldwide collaboration in nursing research activities, data consolidation, and increased funding for nursing research endeavors.

They observed that a convergence of factors, including global nurse migrations, a chronic devaluation of faculty by academic programs, a lack of incentives, and a drop in full-time equivalent faculty employment, among other things, is the cause of nursing faculty shortage. The outcomes of the research, according to the authors, show that a change in approach and direction is necessary to solve the lack of nurse educators (Drennan and Ross, 2019). The healthcare department might do this via the creation of new types of nursing education as well as the creation of a mutually beneficial service contract.

Article 2: Transition to nursing faculty: Exploring the barriers

This article will examine the progress achieved on previously planned efforts, such as extending nursing certificate and graduate programs and nurse educators, enhancing graduate student recruitment into faculty posts, and deferring the retirement of present nurses and professors (Bagley et al., 2018). This academic paper is a review of the literature that dives into the subject at hand. Additionally, the authors propose novel solutions to the problem, including expediting the transition from bachelor of science in nursing to doctor of philosophy curricula; ensuring that Advanced Practice Nurses are recruited into faculty roles while the faculty arranges for clinical practice time; and elevating the nursing career image to make it a prestigious profession (Bagley et al., 2018). Additionally, the authors advocated for developing a national certification program for nurse educators and the Department of Health and Human Services to collaborate with other healthcare authorities to resolve the problem (Bagley et al., 2018). The authors observed that linking the general nursing shortage to an absence of nurse educators improves the case for funding and public policy initiatives. The author concluded that some of the existing methods are successful (Bagley et al., 2018). Deferring faculty retirement, for example, has resulted in an estimated considerable increase in the United States’ nursing services shortage. Other practical approaches include expanding certificate and graduate nursing programs and aggressively recruiting graduate students for teaching positions.

Strategies used to address the organizational impact of Nurse Shortage.

As a first step, Advanced Practice Registered Nurses (APRNs) might be recruited to serve as adjunct faculty while faculty members negotiate clinical practice time with the administration. This will ensure that nursing schools always have sufficient nurse educators on their staff (Fraher and Brandt, 2019). Raising the public’s perception of nursing will increase nursing school enrollment, resulting in an increase in the number of people interested in pursuing a career in nursing. In turn, improved remuneration leads to increased demand for the profession, which in turn leads to more funding. In addition, extending the retirement age for nurses and faculty members would ensure that nurses who are currently working in the health care industry stay in the field for a more extended period of time, thereby decreasing the overall rate at which nurses are leaving the area (Drennan & Ross, 2019). Nurse turnover will reduce as the working environment improves, which will result in a reduction in the nursing shortage consequently (Fraher and Brandt, 2019).  If the organization follows these procedures, our healthcare organization’s nurse shortage problem will be resolved.

References

Bagley, K., Hoppe, L., Brenner, G. H., & Weir, M. (2018). Transition to nursing faculty: Exploring the barriers. Teaching and Learning in Nursing, 13(4), 263-267.

Broome, M. E., & Marshall, E. S. (2020). Transformational Leadership: Complexity, Change, and Strategic Planning. Transformational Leadership in Nursing: From Expert Clinician to Influential Leader, 35.

Drennan, V. M., & Ross, F. (2019). Global nurse shortages: The facts, the impact, and action for change. British medical bulletin, 130(1), 25-37.

Fraher, E., & Brandt, B. (2019). Toward a system where workforce planning and interprofessional practice and education are designed around patients and populations, not professions. Journal of interprofessional care, 33(4), 389-397.

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The global healthcare system has significantly improved over the years with serious advancements in technology which has improved the quality of healthcare among the growing patient population. The diversity of healthcare improvements ranges from the advancement in electronic health records, the use of robots in medical surgery has all aided in relieving the healthcare staff some of the duties and responsibilities that increased workload among the providers.

However, despite the tremendous advancements in technology, provision of quality healthcare largely depends on the ability of the providers to incorporate problem solving skills, critical thinking and the use of evidence-based approaches in solving emerging medical conditions.

The shortage in healthcare providers experienced globally has however hindered the provision of quality healthcare due to increase in working hours, high workloads and mandatory overtime which adversely affect patient outcomes by increasing chances of medical errors and nurse burnout (Fraher & Brandt, 2019).

Currently, nurse burnout which is one of the main challenges in healthcare that affects both the healthcare providers and the patients together with their families has ravaged healthcare systems to the point where it has been recognized as a global health hazard in healthcare.

Insufficient healthcare personnel such as physicians and nurses have led to an increase in workloads which has cause immense physical and psychological and emotional strain among the few available healthcare providers managing an overwhelmingly increasing patient population (Costa & Moss, 2018). This paper will evaluate nurse shortage and identify competing needs that impact nurse shortage and address some of the policies that can be implemented to mitigate nurse shortage.

Competing Needs Impacting Nurse shortage

The main approach to the increasing nurse shortage in healthcare facilities across the globe is by implementing policies that increase nurse retention, improve staffing and also promote job satisfaction among nurses. However, the issue of competing needs has been an issue of concern that has hindered the successful implementation of policies to address the issue of nurse shortages in healthcare facilities.

One of the competing needs that hinder the implementation of appropriate policies to address nurse shortages is cost. The cost of healthcare implies all the material and human resources that is expected to be implemented in healthcare organizations to address nurse shortage (Costa & Moss, 2018). Cost has significantly contributed to understaffing of the healthcare facilities as most organizational management feel that attaining the required staff-patient ratio will lead to an increase in organizational cost. Usually, stakeholders perceive the cost of implementing certain policies such as employee motivation, staff retention and appropriate staffing as an organizational burden hence failure to implement the policies. The policy proponents have a responsibility to offer appropriate education to stakeholders on the cost benefit analysis of the policy.

Another competing need hindering implementation of appropriate policies in regard to nurse shortage is the unprecedented increase in older nursing workforce heading retirement. The increase in older nursing workforce that is heading retirement is also affecting the implementation of appropriate policies such as nurse retention. Most of the older workforce usually wants to keep away from the overwhelming duties of healthcare and hence increasing a nurse shortage burden that has already overwhelmed healthcare. The retirement of the older nursing workforce has an adverse effect to the already understaffed nursing population.

Policy influencing Nurse Shortage in my Organization

One of the policies that can be used to address the nursing shortage in healthcare organizations is the implementation of a matrix for staffing (Durosaiye et al., 2018). The matrix for staffing is an essential healthcare tool that is used to determine the number of staffing for each group in healthcare to address the needs of the patients within the specialty group. The matrix is used as the guide to determine the level of staffing needs within an organization for the organizational leadership to make prompt and appropriate adjustments. The use of the matrix is specifically essential because it guides on the maximum number of patients that can be attended to by either nurses or nursing assistants.

A staffing matrix is an essential tool in healthcare because it helps to enhance an effective match between the patient needs and nurse competency. The appropriate nursing staff is directly implicated in healthy outcomes by enhancing the health of the working environment hence leading to better patient outcomes.

Policy Critique and Ethical Considerations of the Policy

According to American Nurses Association (2019), appropriate staffing is essential in promoting better patient outcomes which not only lead to patient satisfaction but also nurse satisfaction as well. The implementation of the staffing matrix will help determine the most effective nurse-patient ratio for better healthcare provision. However, there are challenges that prevent strict adherence of appropriate nurse-patient ration even with the use of the staffing matrix. First, the basis of the matrix is on the number of patients that are currently admitted to each of the units and the likelihood of more patients to be admitted is not considered.

In my organization for instance, the staffing matrix provides for four nurses when the patient population is 32 on the lower side and 35 on the higher side which implies that there are nurses assigned more than 8 patients and also, some patients are admitted mid-shift, further increasing the burden. Another challenge with the policy is that it does not account for the nursing assistants hence, the nurse has an increased burden I the event that some of the patients assigned do not have a nursing assistant.

An ethical issue arising from the policy is the fact that the policy hinders nurses to question the patient load assigned to them hence, nurses cannot reject an unsafe assignment leading to poor patient outcomes and more medical errors.

Strength of the Policy and Challenges in Promoting Ethic

Despite of the shortcomings of the policy, the policy has significant strengths that make it worth implementing within an organization. The major strength of the policy is that it is able to ensure that there is correct staffing in an organization because poor staffing is a major challenge that is affecting healthcare globally. Therefore, the matrix helps the organizational leaders make appropriate staffing to overcome nursing shortages. However, even though the outcome of the policies has positive results, there is a need to regularly evaluate them to ensure that they are able to meet the growing demands for nurses and that the outcomes are refined continuously.

The main challenge in addressing the ethical issues associated with the policy is the fact that a nursing staff coordinator is usually nonclinical staff who doesn’t understand the essential and important healthcare issues that affect nursing staffing. The various nursing decisions made significantly affect nurses and the exclusion from the decision-making process in matters of staffing will adversely affect nurses. According to Registerednursing.org (2020), nurses should be involved in the decision-making process because they have first-hand experience of the various challenges affecting both nursing staff and the patients at large.

Policy or Practice Suggestions to Balance Competing Needs of Resources, Workers, and Patients

One of the policy suggestions to balance competing needs is the implementation of a safety-first culture through implementing and adhering to safe staffing ratios. According to Driscoll et al. (2018), the implementation of appropriate staffing ratio has a direct positive impact on reducing mortality rate in inpatient healthcare facilities. The effectiveness in balancing competing needs while providing safe and quality healthcare is an essential priority where the organization must involve all stakeholders in all decisions.

For instance, staffing decisions must be made with the nurses being involved as part of the stakeholder and a decision-making team so that they can voice present their concerns and also hold the management accountable in providing a safe working environment. The impact of inclusion of nurses in the decision-making process enhances both nurse satisfaction as well as improved patient outcomes through enhanced safety of care. Besides, involvement of nurses in the decision-making process improves nurse retention which ultimately help in minimizing nurse shortage (Kutney-Lee et al., 2016).

Conclusion

The issue of nurse shortage has for a long time been ignored or ineffectively addressed and this has led to a decline in the quality of healthcare. The global shortage in nurses was vividly depicted during the onset and the period of the novel coronavirus which ravaged the healthcare system globally. To address the ever increase in nurse shortage; healthcare organizations must implement policies that significantly address the issues. Besides, there should be a cost-benefit analysis to all stakeholders on the benefits of increasing nurse staffing.

References

American Nurses Association. (2019). Staffing ratios. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/

Costa, D. K., & Moss, M. (2018). The cost of caring: emotion, burnout, and psychological distress in critical care clinicians. Annals of the American Thoracic Society, 15(7), 787-790.

Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., … & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6-22.

Durosaiye, I. O., Hadjri, K., Liyanage, C. L., & Bennett, K. (2018). A matrix for the qualitative evaluation of nursing tasks. Journal of nursing management, 26(3), 274-287.

Fraher, E., & Brandt, B. (2019). Toward a system where workforce planning and interprofessional practice and education are designed around patients and populations, not professions. Journal of interprofessional care, 33(4), 389-397.

Kutney-Lee, A., Germack, H., Hatfield, L., Kelly, M. S., Maguire, M. P., Dierkes, A., … & Aiken, L. H. (2016). Nurse engagement in shared governance and patient and nurse outcomes. The Journal of nursing administration, 46(11), 605.

Registerednurisnig.org. (2020). Ethical Practice: NCLEX-RN. Retrieved from https://www.registerednursing.org/nclex/ethical-practice/