1- Discuss an issue at the clinical area that impacts the quality of patient care. 2- Give an example of how you can actively participate in developing a health policy to benefit patient outcomes.
+
instructions & assignment outline will be sent as attachments
Thank you
FACULTY OF MEDICINE, BIOSCIENCE & NURSING
SCHOOL OF NURSING
BSc (HONS) NURSING
Assignment: Policy and Politics in Healthcare
Code: NBNB 4723
Lecturer:
Name :
Student ID :
Intake :
Word Count: 2006 words
List of Contents
Policy and Politics in Healthcare: Dealing with Inadequate Nurse Staffing. 3
Negative Impacts of Inadequate Nurse Staffing on Quality of Care. 3
Causes of Low Nurse Staffing. 6
Policy and Politics in Healthcare: Dealing with Inadequate Nurse Staffing
The quality of care refers to the extent to which healthcare services provided in specific facilities enhance the likelihood of positive patient outcomes. Quality care encompasses several domains including safety, patient-centeredness, timeliness, efficiency, effectiveness, and timeliness (World Health Organization, 2022). One of the clinical issues that impact quality of care is nurse staffing. As per Chen et al. (2019), appropriate nurse staffing occurs when the number of nurses and their expertise in clinical work aligns with the needs of patients based on the context of the clinical setting. However, many healthcare facilities fail to achieve an appropriate nurse-patient ratio which negatively impacts the quality of care. The purpose of this essay is to describe the impacts of inadequate nurse staffing on the quality of care and provide health policy recommendations that can improve nurse staffing levels in hospitals.
Negative Impacts of Inadequate Nurse Staffing on Quality of Care
Inadequate nurse staffing leads to high nurse-patient ratios which increase nurse workload and reduce the quality of care. According to Griffiths et al. (2018) low nurse staffing increases the risk of adverse events among patients. Nurses are forced to deal with high workloads which lead to increased instances of missed nursing care, a concept that describes cases where care is partially completed, delayed, or wholly omitted. Missed care can lead to deterioration of patients’ conditions and even death. Lasater et al. (2021) add that low nurse staffing increases the risk of hospital-acquired infections such as sepsis in inpatient facilities. Nurses play a critical role in implementing protocols for preventing these infections including constant screening, risk identification, early diagnosis, and treatment. When nurses have high workloads, they may be unable to effectively implement infection control strategies such as proper hand washing and may put patients at risk of infection. As per (Mitchell, 2018), infections such as pressure ulcers require nurses to constantly reposition patients and keep their skin clean. However, when nurses have high workloads, they may be unable to implement these interventions which put patients at risk of developing pressure ulcers. Hospital-acquired infections increase length of stay in in-patient facilities which increases the cost of care and may lead to poor outcomes including death.
As per Cooke et al. (2022), low staffing increases the risk of inpatient falls. Nurses play a critical role in fall prevention since they spend more time with patients in comparison to other healthcare professionals and assess patients for fall risks such as age, previous fall history, altered mental status, medication, and poor gait. Nurses also monitor patients to determine any changes in their conditions that may increase the risk of falls and report these findings to physicians. They also respond to bedside alarms and provide patients with supplies such as appropriate footwear and walkers which reduce the risk of falls. In facilities with low nurse staffing, it is difficult to effectively implement fall prevention measures. Nurses may not be able to respond promptly to bedside alarms due to high workload and may not have time to thoroughly assess patients for fall risk factors.
Inadequate nurse staffing also increases the risk of medication errors. As per Wondmieneh et al. (2020), medication errors happen at any stage of medication preparation and use, including prescription, transcription, dispensing, and administration. However, research indicates that most of these errors occur during the medication administration process. Nurses are tasked with administering medication and can easily make errors such as giving the wrong dose, giving medication at the wrong time, using the wrong drug, omitting doses, or giving medication to the wrong patient. When nurses have high workloads due to inadequate staffing, they may be fatigued and experience inattention, poor judgement, lack of vigilance, and poor concentration which may lead to medication errors. Notably, such errors have negative impacts on patients, nurses, and healthcare facilities. Patients may experience adverse reactions when given wrong medication or wrong doses that may further deteriorate their health conditions leading to longer hospital stays or death. Hospitals spend more money dealing with impacts of medication errors. Nurses who make these errors often experience emotional distress and may no longer be confident in their abilities especially if the error leads to significant harm to the patient’s health.
Low staffing is also associated with increased nurses’ intention to leave their employment positions with job dissatisfaction and burnouts being the mediating factors. Facilities with high nurse-patient ratios force nurses to take on more tasks than they can handle including longer shifts that give little room for rest. High workloads increase the risk of fatigue, stress, anxiety, and physical health issues such as hypertension which lead to job dissatisfaction and high nurse turnover rates (Chen et al., 2019). During the COVID-19 pandemic, nurses experienced high workloads and burnouts which increased the intention of leaving the profession. Saudi Arabian nurses, like other nurses all over the world, experienced high stress levels and were heavily stigmatized based on their interactions with COVID-19 patients. As a result, turnover rates were very high (Al-Mansour, 2021).
Inadequate nurse staffing not only leads to poor quality of care but also decreases patient satisfaction with care. Patient satisfaction is an important metric used to measure healthcare quality. It also affects patient retention, clinical outcomes, and medical malpractice claims made by patients. In facilities with low staffing, nurses pay little attention to patients since they have to take care of many patients at the same time. Therefore, it is difficult for them to develop a positive nurse-patient relationship that is often associated with high quality care and better satisfaction. Other issues caused by inadequate staffing such as delayed responses to patient calls further reduce patient satisfaction with care. Patients affected by preventable adverse events can also sue healthcare facilities leading to significant financial losses. Poor satisfaction also reduces the reputation that healthcare facilities have within the community and patients may avoid such facilities (Hong and Cho, 2021).
Causes of Low Nurse Staffing
Appropriate nurse staffing levels can only be achieved if there is access to sufficient skilled and experienced nursing professionals by all hospitals. However, there are many factors that have contributed to nurse shortages all over the world. The aging population has contributed significantly to nurse shortages in developed countries like the U.S. and Canada. As people age, they are more likely to suffer from chronic illnesses hence they require more care which is likely to strain the workforce leading to shortages (Tamata et al., 2021). In Saudi Arabia, the aging population is also expected to increase to more than 20% of the general population by 2050 implying that there will be a significant increase in demand for healthcare services (Alluhidan et al., 2020). The nursing workforce has also been impacted by aging since many nurses are reaching the retirement age. Even as more nurses retire, less people are taking up nursing programs which further reduces the likelihood that healthcare facilities will access sufficient staffing (Tamata et al., 2021).
Apart from demographic changes, another factor leading to nurse shortages is high nurse turnover rates attributed to issues such as nurse burnouts and the need to start families. Nurse burnout is a common issue experienced when nurses have high workloads with little time for rest and no work-life balance. High workloads increase of job dissatisfaction which leads to high absenteeism and nurse turnover rates. Saudi Arabia, unlike many other countries, has many male nurses since it is a patriarchal society that exerts a strict code of conduct on women. Women face significant cultural barriers which prevent them from entering the nursing workforce (Alluhidan et al., 2020).
Some developed countries rely on expatriate nurses to improve nurse staffing levels in healthcare facilities. Saudi Arabia, for instance, relies on expatriate nurses from the Philippines and India to reduce nurse shortages. However, issues such as insufficient clinical experience, high workloads, language barriers, and cultural barriers prevent expatriate nurses from providing quality care. Culture shock is especially a significant issue that prevents nurses from adjusting to new countries and results in high attrition rates. Saudi Arabia is generally a Muslim country that strictly adheres to Islamic traditions regarding gender segregation and restriction of movement for women. Some expatriate nurses tend to be overwhelmed by such traditions and may prefer seeking for employment opportunities in other more developed countries such as the UK, USA, and Canada. Additionally, some expatriate nurses may not fully understand the culture of the country and how it influences healthcare hence they are often unable to provide culturally-relevant care. Issues such as discrimination by Saudi Arabian nurses and high living expenses also increase turnover rates among expatriate nurses (Alsadaan et al., 2021).
Recommendations
After analysing the impacts of inadequate nurse staffing in healthcare facilities, it is important to consider policy recommendations that will increase the number of nurses available in these facilities. Alluhidan et al. (2020) recommend that a safe nurse staffing standard should be established and implemented as a law that should be followed by all facilities. The staffing standards should also be higher in hospital units with severely ill or injured patients such as intensive care units.
It is also important to deal with nursing shortages to ensure that healthcare facilities can access sufficient skilled and experienced nurses. In Saudi Arabia, policies that expand the capacity of nursing education should be implemented. Mechanisms such as establishment of more nursing schools and improving the curriculum should be implemented. The Ministry of Education should be at the forefront of implementing these policies and should identify curriculum gaps that need to be filled to improve the quality of nursing education. Nursing students should have access to financial and social support needed to complete their studies. To improve nursing skills, specialty certificates, doctorate, and master’s qualifications should be created and readily availed to nursing students (Alluhidan et al., 2020).
Nurse retention strategies can also help improve nurse staffing levels in healthcare facilities. Opportunities for career progression and continuous skill improvement can help improve job satisfaction among nurses and reduce turnover rates. Healthcare facilities should also consider expanding their staff by employing more nurse assistants and other supportive staff to give room for nurses to practice what they studied for instead of taking up all supportive roles in healthcare units. Nurse salaries should also be increased to improve retention. Other benefits such as housing subsidies may also attract more people to the profession. The image of the nursing profession in Saudi Arabia should also be improved. Most people view nurses as hired helps hence there is need to position nursing as a science-based high-tech job (Alluhidan et al., 2020).
Nursing students can actively participate in the development of health policies that improve nurse staffing and lead to better patient outcomes. As a student, I feel like the best step is to join a nurses’ association, such as the Saudi Nurses Association, to get a better chance to be involved in health policy development. I also intend to educate myself on legislative processes and take part in public forums that focus on advancing the plight of nurses and patients.
Conclusion
Inadequate nurse staffing is a significant clinical issue that reduces the quality of care by limiting patient safety. Low staffing levels increase nurse workloads which lead to fatigue and burnouts. When nurses experience burnouts, they are more likely to make medication errors. They also have less time to implement infection prevention measures which increases the risk of hospital-acquired infections such as sepsis and pressure ulcers. Hospitals with inadequate staffing also experience higher rates of inpatient falls. Burnouts also increase nurses’ intention of leaving the profession due to job dissatisfaction. Patients treated in hospitals with inadequate staffing also demonstrate lower levels of satisfaction with care. Low nurse staffing is currently attributed to nursing shortage and an increasingly aging population which needs more healthcare services. Health policies that establish nurse staffing standards for hospitals should be established. Other strategies such as expanding nursing education, improving nurse salaries and benefits, and improving the image of nursing as a profession should be considered in Saudi Arabia.
References
Alluhidan, M., Tashkandi, N., Alblowi, F., Omer, T., Alghaith, T., Alghodaier, H., Alazemi, N., Tulenko, K., Herbst, C., Hamza, M. and Alghamdi, M., 2020. Challenges and policy opportunities in nursing in Saudi Arabia. Human Resources for Health, 18(1).
Al-Mansour, K., 2021. Stress and turnover intention among healthcare workers in Saudi Arabia during the time of COVID-19: Can social support play a role? PLOS ONE, 16(10), p.e0258101.
Alsadaan, N., Jones, L., Kimpton, A. and DaCosta, C., 2021. Challenges Facing the Nursing Profession in Saudi Arabia: An Integrative Review. Nursing Reports, 11(2), pp.395-403.
Chen, Y., Guo, Y., Chin, W., Cheng, N., Ho, J. and Shiao, J., 2019. Patient–Nurse Ratio is Related to Nurses’ Intention to Leave Their Job through Mediating Factors of Burnout and Job Dissatisfaction. International Journal of Environmental Research and Public Health, 16(23), p.4801.
Cooke, M., Fuente, M., Stringfield, C., Sullivan, K., Brassil, R., Thompson, J., Allen, D., Granger, B. and Reynolds, S., 2022. The impact of nurse staffing on falls performance within a health care system: A descriptive study. Journal of Nursing Management, 30(3), pp.750-757.
Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., Smith, G. and Ball, J., 2018. The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), pp.1474-1487.
Hong, K. and Cho, S., 2021. Associations between Nurse Staffing Levels, Patient Experience, and Hospital Rating. Healthcare, 9(4), p.387.
Mitchell, A., 2018. Adult pressure area care: preventing pressure ulcers. British Journal of Nursing, 27(18), pp.1050-1052.
Tamata, A., Mohammadnezhad, M. and Tamani, L., 2021. Registered nurses’ perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative study. PLOS ONE, 16(5), p.e0251890.
Wondmieneh, A., Alemu, W., Tadele, N. and Demis, A., 2020. Medication administration errors and contributing factors among nurses: a cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19(1).
World Health Organization, 2022. Quality of care. [online] Available at: <https://www.who.int/health-topics/quality-of-care#tab=tab_1> [Accessed 28 August 2022].