Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.

Discussion Week 3 Initial Post

 

The Covid 19 pandemic impacted the way healthcare providers were able to care for patients amongst an increased need for isolation.The purpose of technology in healthcare is, first, to improve the quality of care and, second, to assure effective business performance of the organization (Marshall & Marshall, 2011) The increased reliance and utilization of technology, facilitated the usage in healthcare via telehealth.  By working together telehealth enabled patient’s and organizations a unique way to continue to provide care.

Prior to the Covid 19 pandemic the wide utilization of telehealth occurred in rural demographic areas. Telehealth provides access to resources and care for patients in rural areas or areas with provider shortages, improves efficiency without higher net costs, reduces patient travel and wait times, and allows for comparable or improved quality of care (Gajarawala & Pelkowski, 2021) Usage of these services was limited, due to lack of reimbursement from health insurance agencies. The Covid 19 Pandemic led to a significant increase in the utilization of telehealth services throughout healthcare. 

To facilitate better care legislation was granted on March 13, 2020, President Trump announced widespread expansion of telehealth services for Medicare beneficiaries and relaxation of rules so that seniors could avoid exposure to COVID-19 in physicians’ offices and clinics and virtual consultations could help triage patients for further treatment as necessary (McGonigle & Mastrian, 2021) The legislation allowed for numerous beneficial changes to occur for providers and patients. In the United States, a number of federal and state emergency orders enacted in the early weeks of the pandemic, and a number of expanded reimbursement policies, cleared the way for telehealth to take over as the primary strategy for maintaining continuity of care across the pandemic (Comer, 2021) Healthcare organizations were now more adept to instituting these services in various areas.

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My healthcare organization met this change in our outpatient  outpatient mental health department to specifically meet the needs of the stakeholder or patient. Medication checks, therapy appointments and “quick care, primary care” visits are a few examples of the services that instituted and utilized via telehealth during the pandemic. As a result, it shows potential to enable more effective and cost-efficient diagnostics, provide rapid care to patients most in need, improve personalization of care, and ease provider fatigue. (Mahajan & Mahajan, 2021)

To enable provider satisfaction and retainment of physicians my organization instituted new policy. As healthcare workforce generally, ages issues of retaining experienced workers and important (Marshall & Marshall, 2011) The institution of the policy enabled physicians who lived out of state to utilize telehealth on their scheduled weekend to continue to provide care to patients within the organization. In person care was provided by a APRN, who worked cohesively with the covering physician. Harrar states that a Pennsylvania study found that that advanced practice psychiatric nurses were more likely than psychiatrists to live in rural areas. This statement provides support that the utilization of APRN’s will continue to be critical in providing care to patients amid provider shortages.

Telehealth’s expansion at a rapid pace in order to facilitate care, saw the rapid creation and implementation of new policies in order to facilitate a scope of practice. As a result there is large variation in the scope of practice in each state.  Telehealth also faces many legal and regulatory hurdles including large variations in rules, regulations, and guidelines for practice (Gajarawala & Pelkowski, 2021) Marshall identified that challenges in licensure and practice across state boundaries, access and insurance coverage to patients, fair reimbursement by providers, patient privacy, legal issues and continuing advancements in technology are a few barriers along the way. Advocation for the institution of uniform practice standards nationwide will be a significant area of concern in the future. 

 As technology continues to make advancements there will be new challenges that present providers, patients and organizations. By advocating for changes that allow for the best outcomes to enhance quality care for patients, healthcare professionals can significantly enhance the road for change to occur. Through policies and legislation affects means can be instituted to meet the needs of the population. 

References

Comer, J. S. (2021). Rebooting mental health care delivery for the covid-19 pandemic (and beyond): Guiding cautions as telehealth enters the clinical mainstream. Cognitive and Behavioral Practice, 28(4), 743–748. Retrieved June 14, 2022, from https://doi.org/10.1016/j.cbpra.2021.09.002

Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth benefits and barriers. The Journal for Nurse Practitioners, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013

Harrar, S. (n.d.). Inside america’s psychiatrist shortage (special report). Psycom.net – Mental Health Treatment Resource Since 1996. Retrieved November 3, 2021, from https://www.psycom.net/inside-americas-psychiatrist-shortage

Mahajan, A., & Mahajan, S. M. (2021). Deep learning methods and their application to nursing workflows. CIN: Computers, Informatics, Nursing, 39(1), 1–6. https://doi.org/10.1097/cin.0000000000000702

Marshall, E. S., & Marshall, E. S. (2011). Transformational leadership in nursing. Springer.

McGonigle, D., & Mastrian, K. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

Iris Cornell WALDEN INSTRUCTOR MANAGER

Abby response from the instructor

 

Abby thanks for sharing. What would be a policy in your organization to address the issues?

Annita Ngayap 

RE: Discussion Week 3 Initial Post

 

 Annita Ngayap. Discussion response#2

Hello Abby,

I agree with you on the use of telemedicine during the Covid 19 pandemic, which has transferred to a global phenomenon as it is widely uses in different healthcare settings. The use of telehealth, according to research by Monaghesh 4 Hajizadeh (2020), improves the provision of health services. The use of telehealth technology is a twenty-first century approach that is both patient-centered and protects patients, physicians, as well as others.  The benefits in using technology of telehealth, especially in non-emergency / routine care and in cases where services do not require direct patient-provider interaction, such as providing psychological services. Remote care reduces the use of resources in health centers and improves access to quality care.  Futhermore, telehealth can help us avoid direct physical contact and minimize the risk of infection transmission and finally provide continuous care to the community. 

Reference

Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: a systematic

              review based on current evidence. BMC public health, 20(1), 1193. https://doi.org/10.1186/s12889-020-09301-4

Sarah Leatherwood 

RE: Discussion – Week 3

 

            The nursing shortage continues to be a chronic and stressed issue that has increased since the COVID-19 pandemic (Bourgault, 2022). Nurses working in stressed conditions cause nurses to leave the profession (Rosseter, 2020). Nurses are challenged daily to provide high-quality care while resources are removed (Kelly & Porr, 2018). When events occur regularly where nursing feels undermined due to the changed healthcare structure, tensions and high stress can cause harmful workplace aggression. Ethical conflicts influence the nurse, the nursing profession, and the patients (Kelly & Porr, 2018). Nurses are encouraged to speak to leaders, organizations, and legislators to understand the work environment so it can be improved with policies and practice changes while engaging the nurse in their work. Policies can change where nurses feel comfortable speaking up and influencing change instead of staying quiet. As I have said many times throughout my nursing career, nothing will change even if I say anything, and it feels like I am just complaining. Committees are an essential place for nurses to have a voice to speak up to leadership and encourage positive change to help provide high-quality care and discuss ethical dilemmas and make recommendations for change.

Many competing needs impact the nursing shortage like an increase in the complexity of the patient, high nurse turnover and retirement rate, staff silence, and nurses’ education level. Policies are essential to help decrease nursing burnout by evaluating patient-nurse ratios, patient acuity, and the level of education. Strategies to promote a positive work environment where leaders support and encourage growth while allowing for the time for nurses to provide excellent care are imperative. Raising awareness of the disconnect created between agendas in the organization and the ethical obligation of nurses to provide a specific standard of care is an initial step in changing and creating policies to improve the nursing shortage and the culture of nursing (Kelly & Porr, 2018).

Bourgault, A. M. (2022). The nursing shortage and work expectations are in critical condition: Is anyone listening? Critical Care Nurse, 42(2), 8–11. https://doi.org/10.4037/ccn2022909

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6

Rosseter, R. (2020). American Association of Colleges of Nursing: The voice of academic nursing. News & information. https://www.aacnnursing.org/news-information/fact-

sheets/nursing-shortage

Evelyn Smith 

RE: Discussion – Week 3 Main pos

How competing needs may impact the development of a policy

Competing needs, such as the needs of patients, workforce, and resources may impact the development of a policy because the competing needs should align with the agenda that policy is advocating for.   For example, a policy addressing adequate nurse staffing is required to meet the patient and workforce needs while minimizing financial cost.  According to Lopez et al (2015), the effective utilization and deployment of the workforce are of great importance to ensure efficient delivery of healthcare services in terms of quantity, quality, and cost.

Failure effectively deploys the workforce which might lead to a shortage or oversupply of clinical staff. For example, an oversupply of clinical staff might result in economic inefficiencies along with misallocated resources under the guise of adequate staffing. The shortage of staff relates to numerous negative impacts, including lower quality and quantity of care because there are few resources to offer the essential services; work overload of the available nurses leading to burnout, eventually compromising patient safety; and longer waiting times because of inadequate staff leading to preventable patient deaths (Lopez et al, 2015).

Specific competing needs that may impact workload

A good fit between nursing staff and patients’ needs are specific competing needs that may impact workload as a national healthcare issue. Organizations are exploring schemes of ensuring a good balance amid nursing staff expertise, size and patient needs to ensure quality and safe care along with outstanding services to patients while ensuring operating costs are sustainable (van den Oetelaar et al, 2016).

van den Oetelaar et al (2016) claim that nursing capacity should be optimally matched to the needs of patients which is achievable through a sensible and fair distribution of nurses in units, leading to a workload that is equally distributed and manageable for the nursing staff. This necessitates a good balance between nursing staff and patients’ needs. One scheme of ensuring an appropriate balance is the managing workload for nursing staff. This balance the needed resources with the available resources, which in turn averts additional costs for overstaffing a unit and averts a decline in employee engagement or patient experiences by understaffing a unit.

The impacts and how policy might address these competing needs

Workload has an impact on both patient and staff needs as well as an organization’s resources.  High causes burnout which leads to errors and poor patient outcomes. High workload also has an impact on nurse job dissatisfaction and burnout, and the intention of nurses to leave. High nursing staff turnover resulting in increased costs for using temporary employees or training new nurses (van den Oetelaar et al, 2016).

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A policy might address these competing needs by ensuring an optimal nurse to patient ratio which can improve nurse staffing in organizations and improved care outcomes for patients. The policy can outline a particular nurse to patient ratio depending on the type of unit within a healthcare facility.  For instance, the ratio for a surgical and medical unit can be 5: 1, meaning one nurse will be assigned to five patients at most, while in the intensive unit ratio can be 2:1.  As suggested by Livanos (2015), having a staffing policy in a facility can improve the working conditions for the nursing staff as well as the superiority and safety of care.  In turn, costs of adhering to the ratios can be offset by less need for training new nurses or temporary nurses and reduced turnover of the nursing staff.

 

References

Livanos, N. (2018). A Broadening Coalition: Patient Safety Enters the Nurse-To-Patient Ration Debate. Journal of Nursing Regulation, 9(1), 68-70.

Lopes, M., Almeida, A., & Almada-Lobo, B. (2015). Handling healthcare workforce planning with care: where do we stand? Human Resources for Health13:38.

van den Oetelaar, van Stel, H., Van Rhenen W, et al. (2016).  Balancing nurses’ workload in hospital wards: study protocol of developing a method to manage workload. BMJ Open, 6 (11), e012148.

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 Josh Bruce 

RE: Discussion – Week 3 Main post

Evelyn,

            Good post. Nursing is a great career and rewarding most of the time. There is no doubt that the shortage has started to shift that for many. I work in a pediatric ICU and during the beginning of the pandemic, children did well for the most part. The pediatric units of the hospital were slower than usual initially then began to pick up. Cross training nurses to help is one way in which hospitals can help with a shortage (Patel, 2021). Even if the nurse doesn’t take an assignment, they can be a resource and a “runner” for the nurses in isolation rooms.

            After reviewing more articles regarding the nursing shortage, I found it interesting of all the approaches that are addressed nationwide. Nursing school provides the education to be prepared for the fundamentals of nursing. There is a shortage of nursing teachers, and this impacts the students. If there is a change made to the education of nurses, this could slowly increase the nurses coming into the field. If student nurses are decreased, the trickle effect will only make the shortage worse in the future. I thought this was an interesting read. Thanks for your post (Bowden, 2021).

References

Bowden, V. R. (2021). Predictable Consequences — How Do We Avert a Pediatric Nurse Shortage? Pediatric Nursing, 47(1), 5–10.

Patel, S., Hartung, B., Nagra, R., Davignon, A., Dayal, T., & Nelson, M. (2021). Expedited Cross-Training: An Approach to Help Mitigate Nurse Staffing Shortages. Journal for Nurses in Professional Development, 37(6), E20–E26. https://doi.org/10.1097/NND.0000000000000738

Salena Oglesby 

RE: Discussion – Week 3

Developing Organizational Policies

No one is immune to mental disorders, although these conditions are more common in the poor, adolescents, unemployed, abused women, and the elderly. Effective intervention for mental disorders requires adequate resources. Unfortunately, one in five citizens is reported not receiving mental health treatment needed due to a lack of resources which have played a significant role in overall mental health in American citizens (Kilbourne et al., 2018). The resources may be unavailable due to a person’s location and income.

             Competing Needs Impacting the Lack of Mental Health Resources

Limited resources and constrained staffing ratios usually constitute a significant gap in providing exemplary patient care and barriers to motivation among healthcare workers (Kelly & Porr, 2018). First, the competing needs that lead to decreased mental health resources include the high demand for help in other departments, such as the emergency departments. The second impact is that few patients will not seek healthcare due to stigmatization. For example, in the emergency department, someone will always prioritize resources where patients need urgent physical care over mental health care; this causes mental health facilities to receive inadequate resources. Unfortunately, more healthcare givers are allocated in all other departments than in psychiatric departments.

          Addressing Competing Policies

I would recommend a policy that has enough healthcare workers and resources for all patients. The higher the number of patients, the more healthcare workers, and resources that should be available in all departments. Enough Resources and healthcare workers should be placed explicitly in psychiatric departments, Reduced healthcare workers and resources result in burnout syndrome for healthcare givers (Bridgeman et al., 2018). The existing policy of sharing resources with other departments is an inconvenience. For example, the psychiatric department may share its resources with the emergency department. Before they acquire new allocations, they may lack enough to give care to their patients, leaving their patients waiting for necessary care.

 

 

References

Bridgeman, P. J., Bridgeman, M. B., & Barone, J. (2018). Burnout syndrome among healthcare professionals. The Bulletin of the American Society of Hospital Pharmacists, 75(3), 147-152. https://doi.org/10.2146/ajhp170460

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/OJIN.Vol23No01Man06

Kilbourne, A. M., Beck, K., Spaeth‐Rublee, B., Ramanuj, P., O’Brien, R. W., Tomoyasu, N., & Pincus, H. A. (2018). Measuring and improving the quality of mental health care: a global perspective. World psychiatry, 17(1), 30-38. https://doi.org/10.1002/wps.20482

 

Iris Cornell WALDEN INSTRUCTOR MANAGER

Salena response from the instructor

Salena Oglesby 

RE: Salena response from the instructor

 

judith ihediwa 

RE: Discussion – Week 3

 

Iris Cornell WALDEN INSTRUCTOR MANAGER

Judith response from the instructo

Judith good posting noted. You mentioned “A staff policy is essential for improving the working environment and care delivery of nursing staff. Reduced training or the use of temporary nurses can help mitigate the expense of these consequences”. Do you think this would be something to pursue at your organization to get such a policy to help with the situations? Why or why not?

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Azsia Rempel 

RE: Discussion – Week 3

 

There is no more important time to talk about resources and competing needs in healthcare than now. The past few years have been such a challenge in healthcare, and specifically in this conversation of limited and competing needs. COVID-19 has undoubtedly stretched healthcare workers to their absolute limits. Kelly and Poss (2018) stated, “RNs are constantly challenged to provide quality nursing care, while resources are chipped away, in addition to their energy, pride, and ultimately their capacity to fulfill holistic patient and family healthcare needs.” And this was said pre-pandemic, imagine the burden this very stressor has in present day.

A very important aspect of nursing, that all nurses become acquainted with even as student nurses is the Code of Ethics. The nursing Code of Ethics serves to define a set of goals and guidelines for nursing that, “encompasses the protection, promotion, and restoration of health and well-being; the prevention of illness and injury; and the alleviation of suffering, in the care of individuals, families, groups, communities, and populations” (American Nurses Association, 2015). It aims to guide nurses to provide the best, most safe, and most ethical care they can. This is an essential part of nursing but is often times challenged when situations occur where resources are slim, the staff is short, and there are competing needs across the field. Especially in the reality we are in, a nurse being ethically aware is vital in order to be able to address the complexity of the healthcare environment. “Developing ethical awareness is one way to empower nurses to act as moral agents in order to provide patients with safe and ethical care” (Milliken, 2018).

The stressor I previously identified was staffing shortages and burnout in healthcare, which goes hand in hand with this conversation. Staffing shortages are, and have been, a huge hindrance in providing safe, ethical, quality care. Staff shortages have led to increased workload and nurse-to-patient ratios and so much more that contributes to a true ethical dilemma. It is true when there is a limited resource, it can often lead to a push or spark for necessary policies to become reality. However, it does not always mean they will be implemented or will be long-term. Since the harsh limit on resources and staff in recent years, conversations about healthcare workers’ well-being have been more present than they previously had. However, the actual implementation of those interventions and policies is of a lesser degree.

 

 

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.

Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-only

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to

enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1).

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of

Issues in Nursing, 23(1). Manuscript 1. doi: 10.3912/OJIN.Vol23No01Man01. Retrieved from https://content.waldenu.edu/content/laureate-academics/wal/instances/ms-nurs/nurs-6053-210830-210711/module-02.html#section_container_15_332051215

 

Sarah Leatherwood 

RE: Discussion – 

Nurses are responsible for the lives and health of millions while dealing with high levels of stress which affects their own health and has a negative impact on productivity, retention, and overall patient care (Hersch et al., 2016). Nursing burnout is characterized by emotional exhaustion, depersonalization, and decreased personal development, harming health care (Suleiman et al., 2020). The consequences are severe for patients and staff as it causes poor quality of care, negative patient experience, and adverse safety events (Dall’Ora et al., 2020). It is known that nursing burnout is a global concern, but what can be done about it? It is important to make nurses a priority in assisting to care for them as they care for the patients. Suleiman et al, completed a systematic review that revealed that a mindfulness program initiated for nursing does help decrease nursing burnout (2020).

There are significant differences in nursing outcomes in Magnet-designated hospitals versus non-magnet along with a difference in being inspired by a shared vision and challenging processes (Fisher & Nichols, 2019). Magnet hospitals stress maintaining a shared governance model that empowers nurses to challenge their current practices to improve patient outcomes. Just because an organization is not Magnet designated, shared nursing governances where nurses’ voices are heard and shared should be adopted worldwide.

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human Resources for Health, 18(1), 41. https://doi.org/10.1186/s12960-020-00469-9

Fischer, J. P., & Nichols, C. (2019). Leadership practices and patient outcomes in Magnet® vs. non-Magnet hospitals. Nursing Management, 50(5), 26–31. https://doi.org/10.1097/01.NUMA.0000553496.63026.95

Hersch, R. K., Cook, R. F., Deitz, D. K., Kaplan, S., Hughes, D., Friesen, M. A., & Vezina, M. (2016). Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research, 32, 18–25. https://doi.org/10.1016/j.apnr.2016.04.003

Suleiman, M. N., Gomez, U. J. L., Aguayo, E. R., La Fuente, G. A. C., De La Fuente, S. E. I., & Albendín, G. L. (2020). The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta-analysis. Journal of Advanced Nursing, 76(5), 1124–1140. https://doi.org/10.1111/jan.14318

 

Iris Cornell WALDEN INSTRUCTOR MANAGER

Sarah response from the instructor

 

Sarah Leatherwood 

RE: Sarah response from the instructor

Kathleen Stogner 

RE: Discussion – Week 3

 

Response Post # 2

Sarah,

You mentioned magnet hospitals, which is something I didn’t know much about until I accepted a position at a magnet hospital. One difference I’ve noted is that there are many nurse-driven protocols at my current magnet hospital, whereas in my previous hospital, there wasn’t as much “trust” given to nursing staff. The Magnet designation is given by the American Nurses Credentialing Center and promotes excellence in nursing. (D’Silva, 2022).

Interestingly, at magnet hospitals, many quality measures were noted, such as decreased nursing staff burnout and less turnover of staff. Patient factors such as pressure injuries and falls were also decreased. (Rodriguez-Garcia, et al, 2020, p. 29). Shared leadership is another highlight of Magnet-designated hospitals. Nurses are empowered to participate in policy decisions, and this shared governance model both improves staff satisfaction and patient outcomes. (Fischer & Nichols, 2019, p. 28).

Where I now work, the nursing culture feels different. Patient caseloads on my med/surg unit average 4-5 patients per nurse. There are many studies going on in the unit. The current one is focused on different techniques to prevent pressure ulcers. When being hired at the hospital, Associate degree prepared RNs sign a contract agreeing to get their BSN degree within five years. Help is available to assist nurses in achieving this goal. A recent literature review supported the importance of BSN-prepared nursing to be the minimal education level for nurses to improve patient outcomes. (O’Brien, et al, 2018, p. E3).

Until accepting my current employment, I had no idea the importance or prestige of a Magnet-designated hospital!

~ Kat

References

D’Silva, S. (2022, June 16). Evaluating the evidence: Are Magnet hospitals better for staff and patients? Nursing Times. https://www.nursingtimes.net/clinical-archive/wellbeing-for-nurses/evaluating-the-evidence-are-magnet-hospitals-better-for-staff-and-patients-06-10-2020/

Fischer, J. P., & Nichols, C. (2019). Leadership practices and patient outcomes in Magnet® vs. non-Magnet hospitals. Nursing Management, 50(5), 26–31. https://doi.org/10.1097/01.numa.0000553496.63026.95

O’Brien, D., Knowlton, M., & Whichello, R. (2018). Attention health care leaders: Literature review deems baccalaureate nurses improve patient outcomes. Nursing Education Perspectives, 39(4), E2–E6. https://doi.org/10.1097/01.nep.0000000000000303

Rodríguez-García, M. C., Márquez-Hernández, V. V., Belmonte-García, T., Gutiérrez-Puertas, L., & Granados-Gámez, G. (2020). Original research: How magnet hospital status affects nurses, patients, and organizations: A systematic review. AJN, American Journal of Nursing, 120(7), 28–38. https://doi.org/10.1097/01.naj.0000681648.48249.16

 

Iris Cornell WALDEN INSTRUCTOR MANAGER

Azsia response from the instruction

 

Azia good discussion on balancing the competing needs. What policy could be developed in your organization to reduce the shortages yet not drain the resources of the organization?

 

Azsia Rempel 

RE: Azsia response from the instruction

Dr. Cornell,

 “The silence of RNs leads many to experience tension and frustration, which can trigger displaced aggression harmful to themselves and the profession as a whole” (Kelly & Porr, 2018). I think one of the first steps in developing policies to prevent nurse shortages and burnout is to allow nurses to speak up, to have a voice, and then that voice to be a driving force in policy making and implementation. Real feedback from the front lines is where policy-making needs to start, because, without that feedback and voice, the real issues are not being addressed. I think policies need to aim at keeping nurses in a safe environment, where they themselves don’t have to make ethical dilemma decisions that risk things like, safety, quality, care, and their own well-being. “Research has suggested that nurses often feel unprepared to manage ethical challenges they face in practice resulting in possible moral distress and burnout” (Miliken, 2018). These can be policies regarding a cap on nurse-to-patient ratios and overtime, essentially policies that aim to set standards and limits to the workload and expectations of nurses that seem to get taken advantage of.

 

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to

enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1).

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of

Issues in Nursing, 23(1). Manuscript 1. doi: 10.3912/OJIN.Vol23No01Man01. Retrieved from https://content.waldenu.edu/content/laureate-academics/wal/instances/ms-nurs/nurs-6053-210830-210711/module-02.html#section_container_15_332051215

Elsa Handy 

RE: Discussion – Week 3

Iris Cornell WALDEN INSTRUCTOR MANAGER

Elsa response from the instructor

 

Josh Bruce 

RE: Discussion – Week

Azsia Rempel 

RE: Discussion – Week 

Elsa, thank you for your post! You bring up a great yet unfortunate point that many healthcare organizations have changed and focused more on the cost aspect versus the patient outcome and experience. This causes a lack of quality of care for patients, but also contributes to a negative experience for healthcare workers. “Healthcare organizations are not always designed to support the Code of Ethics; the business model of healthcare encourages RNs to act in ways that accommodate and advance institutional cost savings, accept organizational norms, and maintain status quo” (Kelly & Porr, 2018). When this shift becomes the priority and the norm, it is only the beginning of the problems that can occur from it. “Nursing goals encompass “the protection, promotion, and restoration of health and well-being” (Milliken, 2018). When nurses can’t do this or are put into situations where they must make ethical decisions that may be at the expense of them or their patients, it causes a heavy increase in stress, thus leading to burnout and nursing shortages. Following the Code of Ethics is essential not only for nurses, but the leadership above nurses. Thus, nurses need to have a voice in determining the needs for safe and quality care, but also a safe and supportive environment for nurses to provide that care. Thanks for your thoughtful ideas Elsa!

 

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to

enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1).

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of

Issues in Nursing, 23(1). Manuscript 1. doi: 10.3912/OJIN.Vol23No01Man01. Retrieved from https://content.waldenu.edu/content/laureate-academics/wal/instances/ms-nurs/nurs-6053-210830-210711/module-02.html#section_container_15_332051215

BUY A PLAGIARISM-FREE ESSAY HERE

ISATU JOHNSON 

RE: Discussion – Week 3 response #1

Desiree Dempster 

RE: Discussion – Week 3

Fatmata Kamara 

RE: Discussion – Week 3

 

Initial Post

Competing Needs and Impact on Policy Development

The hospital management team is responsible for ensuring that their policies protect their workforce and provide quality patient care. An organization must thrive on its stated values to succeed in its line of work (Walden University, 2009b). In doing so, most often, the organization will have to make difficult decisions in managing competing needs by creating priorities and distributing resources accordingly within the organization. For example, the nursing shortage issue is happening nationally due to the different components affecting staff retention and hiring processes, budget constraints, staff burnout, work overload, and compromising patient safety. A policy is advantageous, especially when an organization has competing needs. Policy development helps in leadership decision-making and strengthens organizational compliance with the standard of practice and regulations.

Competing Needs on Nursing Shortage

The distribution of limited resources is an ongoing challenge for healthcare organizations. Nurses are faced with intense workloads due to being short staff while battling high acuity patients, resulting in them not taking meal breaks at the end of their shifts. Most nurses have voiced out that the staffing issues prohibit them from providing quality care, but most organizations will listen and not act on it. This continual cycle has led most nurses to stop voicing their concerns and has become less satisfied and discouraged about their job and rather suffer in silence (Kelly & Porr, 2018). 

One of the main barriers to solving the nursing shortage is that healthcare organizations want to stay within their financial budget to provide for other resources. Due to budget constraints, nurses are overworked and burnout. According to Agustina and Tahlil (2022), nurses’ burnout plays a significant role in the type of care given – it affects the hospitals’ nursing quality services and errors in nursing care. Knowing this, organizational leaders should learn how to appropriately balance their financial budget and simultaneously help provide adequate staffing to decrease the burnout associated with the nursing shortage. Most hospitals adopted the policy of partnering with agencies and hired more traveling nurses. Even though this is not a permanent solution; however, it helps solve the nursing shortage short term.

How Can Policies Address the Competing Needs

A policy can be enacted to address the competing needs of nursing shortage by ensuring an optimal staffing ratio, improving the staff’s well-being, and enhancing patient care outcomes. In my organization, there are outlined policies already in place; however, the enforcement of these policies is stunted. In the future, it will be crucial if organizations will invest in training new employees with the maximum orientation time, teach them about the organization’s culture and values, and help build their confidence in their practice by providing them with transitional programs. Also, the hospitals should invest in unit clinical educators to help these new employees acclimate to the working environment, assess their capabilities of coming off preceptorship, and provide continuing professional development courses. Lastly, the organization can provide a policy on how many patients a nurse can care for—for example, enforcing the needs of an IMCU ratio to be 3:1 and medical-surgical unit 5:1 no matter the staffing needs as patient safety takes precedence. An organization that shows such moral and ethical support to its workforce equips its nurse to be ethically aware of their practice and can guarantee that the community they serve needs will be met (Milliken, 2018).

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References

Agustina, & Tahlil, T. (2022). Nurses’ burnout and its associated factors and impact on the

quality of nursing services. International Journal of Nursing Education, 14(2), 24–33. https://doi.org/10.37506/ijone.v14i2.17982

Kelly, P., & Porr, C. (2018) Ethical Nursing Care Versus Cost Containment: Considerations to

Enhance RN Practice.  OJIN: The Online Journal of Issues in Nursing 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Milliken, A. (2018) Ethical awareness: What it is and why it matters” OJIN: The Online Journal

of Issues in Nursing 23(10), Manuscript 1. doi: 10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html

Walden University, LLC. (Producer). (2009b). Working with Individuals [Video file]. Baltimore,

MD: Author.

Briann Li Mandri 

RE: Discussion – Week 3

Teri Pettaway 

RE: Discussion – Week 3 Peer Response #2

Jennifer Castor 

RE: Discussion – Week 3 Jennifer C second response to Briann

Megan Hatfield 

RE: Discussion – Week 3

 

Desiree Dempster 

RE: Discussion – Week 3

Megan Hatfield 

RE: Discussion – Week

Desiree,

I agree and can relate to everything you mentioned in your post. I’ve only been a nurse for 3 years, but I have talked to several managers. They have said that growing nursing responsibilities and limited pay have been a problem for years. I have heard a couple of our most experienced nurses talk about leaving the bedside which would leave me and a few others with less than 5 years of experience on the floor, teaching new grads. I feel so comfortable being able to reach out to my coworkers if I have questions, but that might not be as easy when they leave. For this reason, I feel like our patients will lack proper care, not intentionally, but because we are swamped and are doing our best to care for up to 6 patients at a time.

I found an article that explains why we are losing experienced nurses and what keeps them at the bedside. Hulsey (2021) states that nurses stay at the bedside when they feel connected to their patients, and patients and their families are reliant on their nurses to help them make choices about their care and to educate them. With all the responsibilities that we have in one day of work, something important is almost certainly going to be left out or missed.

In an editorial by Kennedy (2018), she explained how a nurse’s work may not look like much to the patient or family in the room, but in reality, the nurse is taking in information and making critical decisions based on what he or she sees. On top of this, healthcare organizations are focusing on “quality improvement, implementing care bundles, managing new computerized systems and data reporting.” She mentions that even though there is plenty of research done to show the negatives that come from overwhelming the nurse, not much has changed in the field of nursing (Kennedy, 2018).

Resources:

Hulsey, D. M. (2021). Influencing Factors on a Nurse’s Decision to Remain a Bedside Nurse. Walden Dissertations and Doctoral Studies. Scholarworks.

Kennedy, M.  (2018).  What Nurses Do.  AJN, American Journal of Nursing,  118 (5),  7.  doi: 10.1097/01.NAJ.0000532810.66466.29.

Megan

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5 months ago

Desiree Dempster 

RE: Discussion – Week 3

COLLAPSE

Hi Megan,

That editorial by Kennedy, and the article by Hulsey, is good to know!  In reading it, I know already all of that once it is said like that.  It’s really good to see it put out there, like an acknowledgment.

You’ll never believe this.  I was assigned to train a new grad nurse today.  This was at the inpatient psychiatric facility.  They have given her five days of orientation as a new grad because we are so short of nurses, they need her to work the floor as soon as possible!  She is upset because she was always told that new grads get three to six months of orientation.  I’m going to try to fight for her to get more time.  I don’t know what they give the new grads at the medical hospital I work at, but I think it’s more like six weeks.  In any case, it’s not good because new nurses need a proper orientation to feel confident and to be able to properly handle a job that is very complex.  This new grad I worked with today used to be a school teacher.  She became disheartened because of the low pay and the endless work that kept her busy even at home every night.  She has a master’s degree in education.  She’s shocked at the short education period they are providing to new grads. She is looking overwhelmed already.  She came in to it with a passion to help people and I am worried she will again become disheartened.  I hope not.

Thank you for your information!

Desiree

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5 months ago

ISATU JOHNSON 

RE: Discussion – Week 3 response #1

COLLAPSE

Hello Megan

I totally agree with you, indeed safe nurse to patient ratios and safer working conditions are often leading reasons as to why nurses may not stay long in their bedside positions. The impacts of competing needs in care provision have an impact on policy formulation in that there is need to make choices on the use of limited organizational resources. It is all a matter of decision making in the context of economic scarcity of resources. In the selected case of nurse burnout and the need for high nurse-patient ratios and handsome remuneration on one hand and ever present demand for quality care from providers on the other end, if the organization had unlimited resources, it would hire a number of nurses matching or exceeding the number of patients.

The reality however is that money and the supply of nurses are limited resources. Therefore, hospital management makes optimizing decisions as it is impossible to completely satisfy the needs of a single party. There is a compromise on the quality of care provided, and likewise, a compromise on the number of nursing staff and their workloads. Due to these compromises, staff burnout remains an issue which leads to high turnover, loss of skills to the hospital, and errors in care provision that inherently endanger patient safety (Bridgeman et al, 2018). Endangering patient safety from burnout increases the costs of healthcare provision, lengthens the hospital stay period, and in some cases, leads to litigation and losses for the healthcare provider

References

Bridgeman, P. J., Bridgeman, M. B., & Barone, J. (2018). Burnout syndrome among healthcare 

professionals. The Bulletin of the American Society of Hospital Pharmacists, 75(3), 147-152.

Hawryluck, L., & Brindley, P. G. (2018). Psychological burnout and critical care medicine: big 

threat, big opportunity. Intensive Care Medicine, 44(12), 2239-2241.

Hovland, R. T., & Moltu, C. (2019). Making way for a clinical feedback system in the narrow 

space between sessions: navigating competing demands in complex healthcare settings. International Journal of Mental Health Systems, 13(1), 1-11.

REPLY QUOTE

 

5 months ago

Desiree Dempster 

RE: Discussion – Week 3

COLLAPSE

Megan,

In my response to your post, I forgot to mention one thing.  Where you posted, “Lack of safe ratios can in turn cause problems for the hospitals because of this. According to Hill (2017), nurses who obtain lower patient ratios have patients who are 29% less likely to die.”  I was amazed by that number and thought how surely this would cause healthcare facililties to try harder to retain experienced nurses and quit raising nurse to patient ratios!  I mean, what could be more convincing than that?

I read the article by Hill that you cited and it was very interesting.  I learned that these studies suggest that there should be early recognition of burnout in nurses and early intervening (Hill, 2017).  I’ve never seen an article suggest that before and think it is an incredibly useful suggestion!

It was also a good reminder that healthcare facilities should consider, when there is less time for nursing care, the higher costs of possible litigation, medications, wound care, etc. (Hill, 2017).

Thanks again!

Reference

Hill, B. (2017). Do nurse staffing levels affect patient mortality in acute secondary care?  British Journal of Nursing, 26(12), 698–704. https://doi.org/10.12968/bjon.2017.26.12.698

Meron Hailemariam 

RE: Discussion – Week 

Organizational Policies and Practices to Support Healthcare Issues

Explain how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy.

There has been an increase in the number of nurses leaving the bedside. Although there seems to be the notion that those are just the baby boomers making room for the “new wave” of nurses, most nurses are leaving for one profound reason, burnout. It is believed that COVID-19 is the primary reason why most nurses have felt burnt out and decided to leave the bedside, but that is not necessarily true. Schlak et al. (2022) discovered that was a misconception, and the pandemic shined a light on a lot of things that nurses talked about, exposed their concerns, and amplified them. There was a scientific consensus about understaffing, poor work environments, and a lack of an ethical framework correlated with nurse burnout long before the pandemic.

It was discovered that it was the failures of health administrators and political leaders to create a work environment conducive to the delivery of safe care to prevent nurse burnout. The US Department of Health and Human Services recently approved $103 million as part of the American Rescue Plan to strengthen resiliency and address burnout in the health workforce in the wake of COVID-19 (Schlak et al., 2022).

Describe specific competing needs that may impact the national healthcare issue/stressor.

 Caring for patients and delivering adequate, compassionate, and competent care is at the top of every organizational healthcare delivery system. Putting the needs of those providing the care should also be prioritized. I believe that having adequate resources that nurses need to deliver quality care and proper and proper compensation is directly related to patient satisfaction. Many factors contribute to nurses feeling burnt out. Whether the nurse-to-patient ratio is stretched beyond safety or the acuity of patients per nurse is also concerning. The increase of the work demand often does not match the compensation, which is also an issue for nurses. According to Bunjak et al. (2021) is common sense that people will suffer more from psychological exhaustion and burnout when exposed to a combination of different job demands unfolding from various levels within the organization.

What are the impacts, and how might policy address these competing needs?

Magnet recognition and Pathway to Excellence designation are the only approaches shown to improve work environment features that affect nursing and patient outcomes. Having enough resources to deliver safe patient care, fostering positive working relationships with colleagues and administration, empowering management to be responsive to clinician concerns, and promoting nurse autonomy can alleviate burnout (Schlak et al., 2022). Supportive work environments were vital in their research to help minimize burnout.

Kelly et al. (2021) found that evaluating and improving the work environment to reduce burnout is not easy. Still, reducing the nurse’s mental, physical, and emotional demands is critical. The systematic effort involves commitment from all levels of the organization, including but not limited to clinical leadership, human resources, and informatics. Previous evidence reinforces that creating a healthy work environment reduces burnout and improves well-being for nurses. The abundance of evidence on creating a healthy work environment can serve as a roadmap for implementing strategies to reduce work environment demands quickly and effectively.

References

Bunjak, A., Cerne, M., Nagy, N., & Bruch, H. (2021). Job demands and burnout: The multilevel boundary conditions of collective trust and competitive pressure. Human Relations.   https://doi.org/10.1177%2F00187267211059826

Kelly, L. A., Weston, M. J., & Gee, P. M. (2021). A Nurse Leader’s Guide to Reducing Burnout: Strategies to Improve Well-Being. Nurse Leader, 19(5), 467–473. https://doi.org/10.1016/j.mnl.2021.03.012

Schlak, A. E., Rosa, W. E., Rushton, C. H., Poghosyan, L., Root, M. C., & McHugh, M. D. (2022). An expanded institutional- and national-level blueprint to address nurse burnout and moral suffering amid the evolving pandemic. Nurs Manage, 53(1), 16–27. https://doi.org/10.1097%2F01.NUMA.0000805032.15402.b3

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Iris Cornell WALDEN INSTRUCTOR MANAGER

Meron response from the instructor

Precious Knight 

RE: Discussion – Week 3

Iris Cornell WALDEN INSTRUCTOR MANAGER

Precious response from the instructo

Precious Knight 

RE: Precious response from the instructor

Ethical Awareness

Response: Dr. Cornell ethical awareness within an organization is critical to the progression of maintaining a positive work environment. At times of understaffing, nurses are overwhelmed and frustrated and feel that management does not make ethical decisions that support a positive working climate. As nurses’ ethics should be in everything that we do ensuring that we provide the best care for our patients that is moral and within our scope of practice. With the growing awareness about inadequate staffing new policies and procedures are being created within all hospital systems and on higher levels such as congress. The dilemma with the creation of the new policies is the challenge to ensure that the policies being developed incorporate ethical awareness for employees.

Policy Making

Nurses should be a voice during the making of new policies. By participating in the process of creating policies nurses can ensure that all ethical concerns are considered and addressed. As patient advocates nurses have the strongest voice and the greatest insight into the best solutions that can resolve the situation. It is stated that healthcare organizations prefer the input of nurses in policy making because it is what is beneficial for the organization, individuals, communities, and the population (Subia et al.,2020).  A nurse’s goal in patient care is to ensure the well-being of the patient is carried out in conjunction with the patient’s wishes to provide autonomy and in doing so ethical principles are conveyed (Milliken, 2018). Incorporating these attributes in the policy-making process can give nurses and the staff the confidence they need to guarantee that all ethical awareness issues are included in the development of new policies.

Reference

Milliken, A. (2018, January). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html

Rasheed, Subia Parveen,M.N., R.N., Younas, Ahtisham,M.N., B.S.N., & Mehdi, Fahmida,M.Sc, R.N. (2020). Challenges, Extent of Involvement, and the Impact of Nurses’ Involvement in Politics and Policy Making in in Last Two Decades: An Integrative Review. Journal of Nursing Scholarship, 52(4), 446-455. https://doi.org/10.1111/jnu.12567

 

Stephanie Roath 

RE: Discussion – Week 3 Initial Po

How Competing Needs Impact Workplace Safety

Workplace violence (WPV) can have detrimental effects on an organization’s operations and employees in health care settings. It can also lead to high costs and decreased productivity. Some studies also suggest that this condition can affect the psychological and physical health of the attacker (Warshawski et al., 2019). In addition to WPV, other psychological effects can also be caused by violence against health care workers. These include depression and anxiety, as well as burnout and fear. According to studies, violence against health care workers can also affect the quality of care. It can also lead to a decrease in the number of violent suspects receiving treatment and health outcomes (Lassiter et al., 2018). Various factors can contribute to increasing violent episodes in the health care system. These include the length of wait times, patient behavior, and staff behavior. Studies also suggest that the interactions between patients and their relatives can contribute to developing hostile behaviors.

It is also important to note that the media’s portrayal of WPV on health workers can influence the public’s attitudes and interests. For example, a study in Scotland revealed that the negative tone of the news reports about violent incidents against nurses was associated with the prevalence of negative perceptions about the profession (Warshawski et al., 2019).

Specific Competing Needs

Despite the frequency of healthcare WPV, it is still underreported. According to previous literature, about 30% of nurses and physicians report experiencing violence at work. This issue should be acknowledged and discussed to promote public awareness and improve the safety of healthcare workers (Warshawski et al., 2019). There are various barriers to reporting violence at work, such as the perception that it is part of the job, the lack of support from management, and the time constraints involved in filing a report. Some of these include confusion about what types of violence are considered reportable and the lack of time to address the issue. Study findings also suggest that healthcare workers are not always clear about what actions they should take when confronted with violent or criminal situations. This is especially true when the patient lacks control over their faculties.

In 2020, the National Quality Forum launched an action team to prevent healthcare workplace violence (Stand et al., 2021). According to the team, workplace violence can hurt an organization’s reputation and cost it various expenses, such as medical expenses, employee compensation, and litigation expenses. It is also noted that it can lead to a reduction in the quality of care provided. In addition to these costs, the team also found that it can affect the morale of staff members. The team identified various factors that can contribute to a culture of safety in the healthcare industry, such as establishing a standard definition of safety, developing effective data collection methods, and engaging in collaboration efforts. The team also noted that strong leadership and an organization’s commitment to safety are crucial to improving healthcare safety.

In 2008, The Joint Commission released a sentinel event alert warning about the potential effects of workplace violence on healthcare quality. It is noted that it can lead to various issues, such as increasing medical errors and cost of care. It has now added a new standard for preventing violence in the healthcare industry to address this issue (Stand et al., 2021). The new standards, which took effect on January 1, 2022, require healthcare organizations to carry out an annual review of their safety and security policies. This process helps identify areas of concern and implement effective measures to improve safety and security (Stand et al., 2021).

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Policy to Address Competing Needs

Leadership must know the exact nature of WPV issues in their organization in order to identify the appropriate steps to address them. This process is done through multiple methods, such as conducting an assessment, reviewing the data, and developing a committee to recommend solutions (Stand et al., 2021). Before addressing the issue, leadership must also agree on the definition of workplace violence. This helps leadership identify the behaviors that are considered to be harmful to the health of patients and visitors. The Joint Commission’s definition of workplace violence can be a starting point for addressing this issue. In addition, leaders should be aware of the various forms of abuse that can occur in the workplace, such as microaggressions and words. They should also acknowledge that it can happen at any level and affect everyone.

Although various interventions have been tried to reduce violent incidents in health care settings, they have not been able to produce a significant reduction. Therefore, several studies have been conducted on the prevalence of violent incidents among health care workers to understand the phenomenon. These studies have also examined the views of health care workers on the various punitive and preventive measures that could be implemented to reduce the incidence of WPV in their facilities. For example, in 2018, three studies analyzed the views of health care workers on the various preventive measures that could be implemented to reduce WPV incidents in their facilities (Warshawski et al., 2019). According to Warshawski et al. (2019), “Primary prevention includes increased staffing, redesigning the work environment to eliminate danger zones, better communication, and identification strategies, increased security, and establishing and enforcing “zero tolerance” policies. Secondary prevention includes simplifying incident reporting, Code White teams, alarms, and training. Finally, tertiary prevention strategies include a wide range of post-incident supports and legislated measures, such as changes to the Criminal Code, charging perpetrators of violence, and enacting protection of “whistle-blowers.”

 

 

References:

McGuire, S. S., Mullan, A. F., & Clements, C. M. (2022). Workplace Violence in the Emergency Department: Case Study on Staff and Law Enforcement Disagreement on Reportable Crimes. International Journal of Environmental Research and Public Health, 19(11), 6818. https://doi.org/10.3390/ijerph19116818

 Stand, L., Francis, R., Bickford, C. J., & Boston-Leary, K. (2021). Zero tolerance starts now. Nursing Management, 52(11), 18–22. https://doi.org/10.1097/01.numa.0000795588.86737.9a

 Warshawski, S., Amit Aharon, A., & Itzhaki, M. (2019). It Takes Two to Tango: Public Attitudes Toward Prevention of Workplace Violence Against Health Care Staff: A Mixed-Methods Study. Journal of Interpersonal Violence, 088626051984686. https://doi.org/10.1177/0886260519846865

 Lassiter, B. J., Bostain, N. S., & Lentz, C. (2018). Best Practices for Early Bystander Intervention Training on Workplace Intimate Partner Violence and Workplace Bullying. Journal of Interpersonal Violence, 088626051880790. https://doi.org/10.1177/088626051880790

Jessica Lopez 

RE: Discussion – Week 

Week 3 Discussion: Main Post

Competing Needs and Policy Development

                There are various types of competing needs within the healthcare system. This occurs when the conditions of two entities (such as nursing staff, patients, and organizational) co-occur, both seeking simultaneous satisfaction. Competing needs in healthcare substantially impact policymaking and can be positive or negative. Ethical challenges within nursing make policymaking particularly difficult for nurse leaders. As RNs, we aim to provide our patients with high-quality, safe, and ethical care (Miliken, 2018). As reflected in our policies, we act as advocates for our patients and our profession. Nurse leaders may often be met with administrative barriers regarding policy change. For example, a nurse manager may be monitoring patient safety trends and the correlation between medical errors and staffing ratio. The nurse manager may want to create a new policy to change the staffing ratio on their unit to be told: “it isn’t in the budget.” In this situation, the nurse manager would have to devise creative policy development to accommodate the competing needs of staff, patient safety, and costs while maintaining the ethical standards of nursing. Competing needs such as this negatively influence proper nursing policy development and can lead to stress and burnout (Kelly & Porr, 2018). To develop policy adequately, there must be a compromise between competing needs.

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Competing Needs and National Healthcare Issues

                The national healthcare issue I have selected is rural communities’ lack of access to mental health services. Regarding this issue, the competing need is the lack of available resources and patient/staff safety. Simply put, the lack of adequate mental health services in rural areas has led to an increased mental health crisis due to poorly managed mental health needs within these communities. Inpatient psychiatric and substance abuse treatment centers rarely exist in rural communities, which forces those in crisis to seek care at the local emergency departments, where they could wait weeks to transfer to an inpatient facility (Finley, 2020). To complicate things even further, there are high arrest rates secondary to petty crimes committed by those in crisis leading to high rates of incarcerated individuals with severe mental illness (Segal et al., 2018). Most rural outpatient psychiatric care is received in primary care settings by providers that lack comprehensive knowledge, leading to improper care (Finley, 2020).

The Impact of Policy

 Policies regarding access to mental health services could have a tremendous positive impact on rural communities. However, this issue goes beyond an organizational level and should be considered at a county, state, and national level to be addressed appropriately. There are many reasons rural areas lack access to mental health care, and I cannot discuss every barrier in a discussion post. From my experiences living and working as an RN in a rural area, I have noticed that the retention of practitioners and lack of access to advanced education opportunities are two of the most significant barriers to rural mental health. One way to address this would be by creating local policies that address workforce expansion through grant money or loan repayment for local RN and APRNs to advance their education to meet community demands. Individuals with rural backgrounds are more likely to stay within their communities and be successful due to strong community ties (Kverno & Kozeniewski, 2016). Furthermore, policies that remove restrictions on NPs allow APRNs such as PMHNPs to work within their full scope of practice, easing the burden of finding physician oversight in underserved areas and making practicing in such places more difficult.

Resources

Finley, B. A. (2020). Psychiatric Mental Health Nurse Practitioners meeting rural mental health challenges. Journal of the American Psychiatric Nurses Association, 26(1), 97-101. https://doi.org/10.1177/1078390319886357

Kelly, P., & Porr, C. (2018) Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: The Online Journal of Issues in Nursing, 23(1), Manuscript 6. https://doi.org/10.3912/OJIN.Vol23No01Man06

Kverno, K. & Kozeniewski, K. (2016). Expanding rural access to mental health care through online postgraduate nurse practitioner education. Journal of the American Association of Nurse Practitioners, 28 (12), 646-651.

Milliken, A. (2018) Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1),  Manuscript 1. https://doi.org/10.3912/OJIN.Vol23No01Man01

Segal, A. G., Frasso, R., & Sisti, D. A. (2018). County jail or psychiatric hospital? Ethical challenges in correctional mental health care. Qualitative Health Research, 28(6), 963–976. https://doi.org/10.1177/1049732318762370

Iris Cornell WALDEN INSTRUCTOR MANAGER

Jessica response from the instructor

Jessica Lopez 

RE: Jessica response from the instructor

Week 3 Discussion: Response to Another #1

Dr. Cornell,

                Your question really had me thinking. I do not believe there is a straightforward answer and that staff confidence regarding ethical awareness in policy development depends heavily on two factors. The first is staff knowledge, and the second is the environment in which they work. Milliken (2018) states recent studies suggest that ethical awareness may be lacking in the nursing profession, and there is little understanding of how all nursing actions may result in ethical dilemmas. Furthermore, ethical awareness is a developed skill that should be taught as part of a more extensive skill set of ethical competence. The environments in which nurses work lay the foundations for working conditions (including the creation of policy) that coincide with the Nursing Code of Ethics, particularly for nursing executives who ensure that nurses are included in decision-making ( American Nurses Association, 2015). Recently, healthcare organizations have shifted from healthcare models centered around treatment and healing to business models centered around productivity and costs (Kelly & Porr, 2018). This is where the dilemma lies; for nurses to be confident that organizational policy is developed with ethical awareness in mind, they must be able to demonstrate ethical awareness. New nurses starting their careers in poor environments are often not taught how to develop ethical awareness. I refer to this as “the blind leading the blind.” A competent and knowledgeable staff would be the most confident in recognizing ethical awareness in policy.

                I have worked in both environments, ethically and unethically sound facilities. Fortunately for myself, I started at a facility that was ethically aware and nurtured its nurses. Nurses were heavily involved in all policymaking and created all nursing policies. It was not until I moved to a rural hospital I witnessed the latter. It was like night and day, and I immediately noticed that most nurses with outside experience left quickly; those who stuck around were all “homegrown.” Nurses were not involved in policymaking, and it was very apparent most of their policies benefitted the facility and not the patients or staff, creating a highly unsafe working environment. But the nurses with no outside experience (even veteran nurses) were unaware.

References

American Nurses Association. (2015). Code of Ethics for nurses with interpretive statements. Author. Retrieved from Code of Ethics for Nurses With Interpretive Statements (View Only for Members and Non-Members) (nursingworld.org)

Kelly, P., & Porr, C. (2018) Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: The Online Journal of Issues in Nursing, 23(1), Manuscript 6. https://doi.org/10.3912/OJIN.Vol23No01Man06

Milliken, A. (2018) Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1),  Manuscript 1. https://doi.org/10.3912/OJIN.Vol23No01Man01

Salena Oglesby 

RE: Discussion – Week 3

Chanel Graham 

RE: Discussion – Week 3 Response 1

Shilpa Ramekar 

RE: Discussion – Week 3

Iris Cornell WALDEN INSTRUCTOR MANAGER

Shilpa response from the instructor

Shilpa Ramekar 

RE: Shilpa response from the instructor

Jessica Lopez 

RE: Discussion – Week 3

Shilpa Ramekar 

RE: Discussion – Week 3

Annita Ngayap 

RE: Discussion – Week 3

Melissa Schlothauer 

RE: Discussion – Week

Melissa Schlothauer Response to Annita Ngayap

Hello Annita,

            As you discussed competing needs and the corporate prioritization of the business paradigm in healthcare, I was reminded of how Broom and Marshall (2021) pointed out a challenge in measuring productivity and effectiveness in healthcare is due to “insurers, providers, policymakers, and consumers” each having their own ideas of how it should be measured (p. 81). This adds to the complexity of building policy on common ground. It is important for nurses and healthcare leaders to raise awareness about the detrimental effects of the nursing shortage that you pointed out. I appreciated how you mentioned the need for long-term strategies in response to how policy might address the nursing shortage and competing needs. Solvold et al. (2021) suggested leveraging the expertise of health, wellness, and behavioral science experts to guide the implementation of long-term solutions (p. 9). Another helpful suggestion is to engage healthcare workers in the political decision-making process so they can advocate for the ethical standards that will protect the quality of patient care, their own well-being, and the health of their communities (Milliken, 2018). Thank you for your engaging post.

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References

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3 rd ed.). Springer Publishing Company.

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. https://doi.org/10.3912/OJIN.Vol23No01Man01

Søvold, L., Naslund, J., Kousoulis, A., Saxena, S., Qoronfleh, M., Grobler, C., & Münter, L. (2021). Prioritizing the mental health and well-being of healthcare workers: An urgent global public health priority. 

        Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.679397

Angela Rollisson 

RE: Discussion – Week 3- Int

Organizational Policies and Practices to Support Healthcare Issues

Mental health has become a big topic of discussion over the last few years due to COVID-19 lockdowns, record drug overdoses, and school shootings. Evidence of individuals with declining mental health seems to be prevalent in our day-to-day lives, whether we are turning on the television, picking up a newspaper, or taking a walk in the park. It is a topic that requires addressing by policymakers and other community leaders. 

 

“Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise (Milliken, 2018).” This passage makes it all nurses’ duty to address the declining mental health of our society and take a stance of an agreement on limiting access to firearms by those deemed mentally ill by the courts. 

 

The Senate is currently working on bipartisan legislation to address mental health and prevent more school shootings. The public outcry related to the Uvalde school shooting has demanded that action be taken to avoid additional school shootings and has forced Congress to take action.  

The headlines and news stories show that gun control is what the public supports as a means to end school shootings. Many that are against more gun laws argue that the school shootings are not an issue of gun control but rather a mental health issue or that schools need one point of access for entry, a police officer on campus, staff with weapons etc. Lobbyist gun group, the NRA’s official stance is that they ‘will continue to oppose any effort to insert gun control policies, initiatives that override constitutional due process protections and efforts to deprive law-abiding citizens of their fundamental right to protect themselves and their loved ones into this or any other legislation’ (Snell, 2022). President Biden replies the 2nd amendment is not absolute or without limitations. Furthermore, according to Pew Research ‘personal protection’ is the single biggest reason individuals own guns (2021). 

 

To address many needs and concerns of the majority, the Senate is currently drafting legislation with bipartisan support (Democrats and 10 Republicans), that will authorize more thorough background checks on individuals looking to purchase firearms between the ages of 18-21, including opening sealed juvenile records concerning mental illness and criminal activity, and performing background searches on partners of convicted domestic abusers to prevent circumventing. In addition, the law will provide funding for mental health resources, heighten school safety and student safety, and prevent individuals that have been deemed mentally Ill by the courts from purchasing firearms. 

References:

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html

Schaeffer, K. (2021). Key facts about Americans and guns. Pew Research Center. . https://www.pewresearch.org/fact-tank/2021/09/13/key-facts-about-americans-and-guns/

Snell, K. (2022). ​​A bipartisan group of senators announces a deal for school safety and gun measures. NPR. https://www.npr.org/2022/06/12/1104433332/gun-control-senate-deal

 

Iris Cornell WALDEN INSTRUCTOR MANAGER

Angela response from the instructor

Angela thanks for sharing. How is ethical decision-making completed on your unit?

 

Angela Rollisson 

RE: Angela response from the instructor

Hi Dr. Cornell,

[Thank you for the question, it allowed me to put everything in context. ]

The current ethical decision is centered around the patient’s excessive sleeping and to what length should her private duty nurses go to get her up for scheduled events to please her family, a concierge doctor, and the company that contracts us and has a financial motivation. The patient is a 94-year-old woman who complains of fatigue as the cause for why she cannot get out of bed and was recently diagnosed with “end-stage dementia” last Thursday by her concierge doctor.

“For a nursing action to be considered ethical, it should be aimed at promoting the goals of nursing in conjunction with the patient’s wishes (Milliken, 2018).” My team and I have struggled with the best way to resolve the situation. Do you focus on getting the patient up by making persistent requests that may be bothersome to the patient and show a lack of respect for her autonomy? Do we push to get her up for the greater good, to ensure we have a job that will allow us time to study for schoolwork and help more patients? Do we push to get her up because her family pays for the service and they may frown upon us? Do we push her to get up to appease the company that contracts us out?

I have to take into consideration what each team member is currently going through in their personal life, and emphasis must be on them. Many of the nurses on the case are exhausted mentally and physically due to excessive working, the high cost of living in Silicon Valley, depression, loss of a loved one or a loved one dealing with depression. Many nurses need the downtime when arriving at this assignment and don’t want to frequently march into the patient’s room requesting that she do something against her will, and these nurses will argue that it’s the patient’s right to sleep in by the valuing the virtue of autonomy. I had a NOC nurse call me last week to tell me she was expecting a phone call back from our company because she was concerned that the nurses that work dayshift are allowing the patient to sleep excessively. The NOC nurses wanted our company to create a “guideline or procedure” for waking the patient, but this directly contradicts their role because we are independent contractors and abide by the requirements of individual cases, i.e., and family expectations. I strongly encouraged the nurse not to request guidelines because it would look like the nurses were in discord when we must support each other.

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It would be effortless for nurses to start pointing fingers at each other by saying this nurse isn’t doing enough to get the patient out of bed, ect, and this would create stress not only for the nurses but the patient would quickly pick up. ‘Nurses are responsible for contributing to a moral environment that demands respectful interactions among colleagues…and open identification of difficult issues..(ANA, 2015).’ The best way to handle this decision is to continue with a therapeutic environment for the nurse’s communication to remain open and harmonious.

 The problem was recently addressed & resolved by the patient’s concierge doctor, who provided guidelines for the patient’s sleep. The nurses should have the patient out of bed by noon, and if the nurses have trouble, she is to say, “Dr. Black says it is best…” and encourage the patient to push through “very real physiological responses” that make her want to go back to sleep. So far, the tips from the doctor seem to be helping.

References:

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from

https://www.nursingworld.org/coe-view-only

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html

 

Chanel Graham 

RE: Discussion – Week 3 Initial Post

 

NURS 6053 Week 3 Discussion Board Initial Post

Organization Policies and Practices to Support Healthcare Issues

                The nursing burnout rate and staffing shortage have been a national healthcare issue for years, and it continues to be a significant cause for concern amongst healthcare workers. Nurses continue to suffer from the effects of staffing shortages due to stress, burnout, lack of healthcare educators, job dissatisfaction, and high turnover rates (Haddad et al., 2022). Many healthcare organizations have recognized these issues and have created new policies and practices to help fix the nursing shortage issue and reduce the stress and risks of nursing burnout and high turnover rates. Policies, procedures, and new practices are set to improve the workforce, ensure access to available resources, and provide safe and adequate patient care.

Competing Needs and the Impact on Policy Development

                The competing needs within healthcare organizations surrounding the nursing shortage involve the aging population, meeting the patient’s needs, limited staff in healthcare facilities, and finding the balance between maintaining the quality patient care while adjusting to the demands of the job due to the nursing shortage. The aging population of both the patient and staff directly affects patient outcomes. Staff members at an advanced age have reached the age of retirement and have resigned from their positions. Approximately one-third of the nursing workforce is over 50 years of age, and the average age of full-time nursing faculty is 49 years (Nevidjon & Erickson, 2022). This, paired with the increase in staffing shortages, enhances the negative impact on patients’ quality of care. Patients at an advanced age may require additional care and resources. As stated by Park & Yu (2019), the difficulty in supplying and maintaining an adequate number of healthcare providers has made it impossible to respond to growing demands for healthcare services in aging appropriately and has been associated with an increased mortality rate.

Without the proper nurse-to-patient ratio, there is an increased risk of patient error, diminished quality of care, and decreased access to resources that may help diagnose, manage, and treat patient conditions. When patient care is compromised due to decreased staff and limited resources, nurses risk running into possible ethical issues. According to Milliken (2018), to avoid ethical issues within healthcare, one must work to protect, promote, and restore the health and well-being of the patients, prevent additional illness and injury, and alleviate patient suffering. These goals will help to increase job satisfaction, support patient wellness, provide a sense of accomplishment for healthcare workers, and enhance employee morale.

How Policies Might Address Competing Needs

The population faces prevalent healthcare issues that healthcare professionals must manage appropriately. It is essential for medical facilities to develop policies to address the needs for additional employee health and wellness support, hold job fairs to help correct the staffing shortage and reduce employee stress and burnout, and provide access to emotional and social support. Throughout our nations, various policies have been implemented to combat the nursing shortage and burnout rate, such as new payment agreements, emergency hiring plans, RN residency programs, unique contracting systems, rural allowance policies, and recruiting and guaranteeing incentives for nursing graduates and full-time government employment (Park & Yu, 2019). To help ensure that these policies are successfully developed and implemented, it is essential for healthcare organizations to adapt to a multidisciplinary approach with the community, government, and healthcare facilities to achieve the best possible outcomes for both the patients and healthcare workers.

Conclusion

                Healthcare providers are continuing to work in stressful, inadequately staffed conditions. With the growing nursing burnout and staffing shortage, nurses are at an increased risk of anxiety, depression, and stress. Organizations must address these issues and implement policies and procedures to help support the health and well-being of patients and staff members. Once the concerns and issues with the nursing shortage and burnout, there should be an overall improvement in employee satisfaction and the quality of patient care.

References

Haddad, L., Annamaraju, P., & Toney-Butler, T. (2022). Nursing Shortage. Ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK493175/.

Milliken, A. (2018). Ethical Awareness: What it is and Why it Matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. Doi:10.3912/OJIN.Vol23No01Man01. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html

Nevidjon, B., & Erickson, J. (2022). The Nursing Shortage: Solutions for the Short and Long Term. OJIN: Online Journal of Issues in Nursing. Vol. 6 No. 1, Manuscript 4. https://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/NursingShortage/Resources/NursingShortageSolutions.html

Park, H., & Yu, S. (2019). Effective policies for eliminating nursing workforce shortages: A systematic review. Health Policy And Technology, 8(3), 296-303. https://doi.org/10.1016/j.hlpt.2019.08.003

 

ISATU JOHNSON 

RE: Discussion – Week 3 response 2

Hello Chanel,

Staff burnout is a consequence of factors such as too low nurse-patient ratio and increasing demand for quality care by patients and regulatory bodies. These place huge demands on the time and attention of care staff, and in the absence of mediating factors, lead to stressed care providers. The need by patients for high quality care directly competes with nurses’ need for reasonable workloads and reasonable numbers of patients under their care. Given the shortage of nursing staff in the United States, care providers end up overworked and consequently suffering from physical and emotional exhaustion (Hawryluck & Brindley, 2018)The reality however is that money and the supply of nurses are limited resources. Therefore, hospital management makes optimizing decisions as it is impossible to completely satisfy the needs of a single party. There is a compromise on the quality of care provided, and likewise, a compromise on the number of nursing staff and their workloads. Due to these compromises, staff burnout remains an issue which leads to high turnover, loss of skills to the hospital, and errors in care provision that inherently endanger patient safety (Bridgeman et al, 2018). Endangering patient safety from burnout increases the costs of healthcare provision, lengthens the hospital stay period, and in some cases, leads to litigation and losses for the healthcare provider

References

Bridgeman, P. J., Bridgeman, M. B., & Barone, J. (2018). Burnout syndrome among healthcare 

professionals. The Bulletin of the American Society of Hospital Pharmacists, 75(3), 147-152.

Hawryluck, L., & Brindley, P. G. (2018). Psychological burnout and critical care medicine: big 

threat, big opportunity. Intensive Care Medicine, 44(12), 2239-2241.

Meron Hailemariam 

RE: Discussion – Week

Hey Megan, 

Burnout among registered nurses has been a great concern within the U.S. healthcare system and has been reported in many hospitals (Gustaun,2018). As you have mentioned, California is the only state that practices nurse-to- patient ratio allowing nurses to do their job efficiently at the same time keeping the stress level in check. My initial seven years of nursing was in California, where I had first-hand experience on the job. I had never been content with my job, co-workers, and the working environment in general as I did in the Golden State. The hospital I worked at not only applied nurse-to-patient ratio but had contact with outside agencies to replace nurses/CNA’s who miss work. Unlike today where you are forced to cover for example, the RN & Tech job at the same time, California never put its healthcare workers in dire situation.

Unfortunately, I had to change State due to family obligations and found myself in difficult working environment. Where I am working now, there is no nurse-to-patient ratio, working with short staff is the norm and it happens constantly. It gives the word ” burnout ” a new meaning so much so that nurses go to great length to avoid bedside care. Extensive evidence supports the association between increased nurse staffing and improved quality of patient care (de cardiova et al.,2019). In other words, to provide quality care to patients, the staffing problem exposing nurses to work related burnout and stress must be addressed immediately.

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                                                                            Reference

de Cordova, P. B., Pogorzelska-Maziarz, M., Eckenhoff, M. E., & McHugh, M. D. (2019). Public reporting of nurse staffing in the United States. Journal of Nursing Regulation, 10(3), 14–20. https://www.journalofnursingregulation.com/article/S2155-8256(19)30143-7/fulltext

Gutsan, E. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace. Marshall Digital Scholar. https://mds.marshall.edu/mgmt_faculty

Meron Hailemariam 

RE: Discussion – Week 3

Hey Elsa, 

Registered nurses (RNs) are constantly challenged to provide quality nursing care while resources are chipped away, sometimes along with their energy, pride, and ability to provide holistic patient care (Kelly & Porr, 2018). To expect nurses, complete a task without sufficient resources is tantamount to sending soldiers to a battlefield without guns. The pandemic proved or has shown poor preparation manifested amongst healthcare workers particularly nurses. Shortage of beds, manpower, and materials should have been managed by hospitals or higher ups, and yet the burden fell upon nurses causing unnecessary distress. Many have cried unable to provide adequate care to patients as they were supposed to. Only a few lodged a complaint. Speaking up is critical to patient safety (Dixon-Woods., et al, 2018). Some nurses are afraid to step up and verbalize their grievances with the administration. There is no platform available now where nurses can vent their emotions and frustrations. The suppressed emotion unfortunately affects nurses’ ability to perform their task as expected while at the same time risking patient’s safety. Therefore, it’s very important for nurses to step up and have their say in order to safeguard patient’s safety as well as keep their own sanity under control.

Reference

Dixon-Woods, M et al. (2018). “Improving Employee Voice About Transgressive or Disruptive Behavior: A Case 

Study”. AcademicMedicine. http://journals.lww.com/academicmedicine/Abstract/publishahead/Improving_Employee_Voice_About_Transgressive_or.97812.aspx

Kelly, P., & Porr, C. (2018) Ethical Nursing Care Versus Cost Containment: Considerations to

Enhance RN Practice.  OJIN: The Online Journal of Issues in Nursing 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from 

 https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html