Please respond to the discussions APA format with reference

DQ1

Nursing shortage has been a talked about issue for some time now and becomes increasingly urgent as baby boomers age and healthcare continues to become more complex and demanding. The Bureau of Labor Statistics stated that, “the RN workforce is expected to grow from 2.7 million in 2014 to 3.2 million in 2024, an increase of 439,300 or 16%” (Hogan, 2015). With the nursing staff shortage comes higher nurse to patient ratios, leaving an impact on both the staff and the patient experience and outcomes. Many studies have revealed the negative impact that this issue may result in. One study revealed that the more patients to one nurse, over 4 specifically, revealed a significant increase in readmission rates (AACN, 2017). Other studies have shown that this also leads to increased patient mortality rate, shorter hospital stays, and decreased infection rates. Overall, the high workload for nurses pose a risk to the patients, hindering them from being able to spend the time needed with each provide the high-quality care. Nursing is also experiencing high turnover rates and burnt out rates which are associated by the high stress increased even more by the work load due to staffing shortages. I know I have seen many nursing say they cannot do their job to the standard they want to due to not having the time and resources to fulfill their workload, as well as suffer from stress and fatigue associated with it.

There are some strategies put into place to work towards solving this issue. One focus has been on increasing the amount of education opportunities for the nursing career, funding for more nursing programs, increasing the student capacity, and nursing educators. Foundations such as the Institute of Medicine and RWJF have pushed nursing education to expand to higher degrees like bachelors and graduate programs, creating more opportunity and incentive to drive people to enter the field. Many health care facilities are trying to stress the importance of employee retention, working to enhance employee satisfaction.

References

American Association of Colleges of Nursing (AACN). Nursing Shortage Fact Sheet. Received from http://www.aacnnursing.org/News-Information/Fact-S…

DQ2

With regards to the nursing shortage there is a shown to be an increased level of mortality within given patient populations. Studies have shown that according to the American Association of Colleges (AAC) of Nursing, “According to a study published in the October 23/30, 2002 issue of the Journal of the American Medical Association, more nurses at the bedside could save thousands of patient lives each year. Nurse researchers at the University of Pennsylvania determined that patients who have common surgeries in hospitals with low nurse-to-patient ratios have an up to 31% increased chance of dying”. One way that the government is trying to help combat this problem is by passing legislation to help fund nursing schools and give support to staff and students. According to the ACC of Nursing (2018), “The Title VIII Nursing Workforce Reauthorization Act of 2017 (H.R. 959) provides critical support to nursing students, faculty, and programs, which ensures access to care across the continuum and in every community”. This passing could help provide support for many programs and help get students to the next level. This way we are able to replace the soon to be retiring work force of nurses over the next several years.

Reference:

ACC of Nursing. (2018, July 23). Policy & advocacy. Retrieved August 14, 2018, from American Association of Colleges of Nursing website: http://www.aacnnursing.org/Policy-Advocacy

ACC of Nursing. (n.d.). Impact of the nursing shortage on patient care. Retrieved August 14, 2018, from American Association of Colleges of Nursing website: http://www.aacnnursing.org/News-Information/Nursin…

DQ3

The nursing shortage is very much a reality as the “baby boomers” turn 60, the hospital census continues to grow due to ACA and healthcare is surviving the population into their advanced years. Supply and demand combined with the number of current nurses reaching retirement age is posing a severe problem for the future of nursing. “According to the National Council of State Boards of Nursing, 55% of the RN workforce is 50yrs or older” (American Association College of Nursing, 2017). By 2020, the nursing deficit will reach 285,000, which exceeds the shortage of the 1960’s (Buerhaus, 2008).

“The effects of the nursing shortage have been demonstrated by less than favorable outcomes in recent studies regarding patient safety, infection rates, failure to rescue, and mortality rates” (AACN, 2017). These facts are significant as they dispute the cost/base theory supported by hospital administration regarding a lean “nurse/patient matrix”. Another impact seen of the nursing shortage is the influence it has on new graduates entering the nursing profession. This is noted in areas such as decrease staffing which leads to insufficient orientation, lack of mentoring and a failure of support for the “new” staff nurses.

To resolve the nursing shortage, it is important for all parties vested, such as the state along with the health care industry to collectively focus on addressing this issue. Many of the states have adopted the Nurse Residency programs to help acclimate the new BSN nurses into the workforce of the hospital (AACN, 2017). These programs will help the hospital and the nursing community by providing longevity within the profession. Nursing leadership is instrumental in facilitating positive practice environments which enhances nurse retention and facilitates quality patient care. “Nursing leadership should also be at the forefront of evidence-based change with the ability to impact the work force and reduce turnover” (Twigg & McCullough, 2014).

Reference:

American Association of Colleges of Nursing. (2017, May 18). Nursing Shortage Fact Sheet. Retrieved from http://www.aacnnursing.org/News-Information/Fact-S…

Buerhaus, P. (2008, November 26). Current and Future State of the US Nursing Workforce. Retrieved from http://jamanetwork.com/journals/jama/article-abstr…

Twigg, D., & McCullough, K. (2014). Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51(1), 85-92. http://dx.doi.org/10.1016/j.ijnurstu.2013.05.015

DQ4

When I was a child I remember hearing about the shortage of nurses, and this is one of the reasons I decided to become a nurse. Forty years later the nursing shortage still exists, and it is projected to become worse as time passes. Turnover is a significant contribution to the nursing shortage, and the inability to retain nurses profoundly impacts patient care.

In 2014, Marshall University researchers completed a study to determine the root problems contributing to nursing turnover and the underlying factors driving the nursing shortage in the United States of America (Coustasse, Cox & Willis, 2014). The study determined several factors “explain the cause of the nursing turnover and the lack of available skilled nurses within the U.S.; job dissatisfaction, RN age increases, demographic changes in patients, insufficient staffing, recent turnover, and supervisor control” (Coustasse, Cox & Willis, 2014, p.1).

“High turnover rates are a growing problem for healthcare providers and is causing increased expenses and draining financial assets for every open position within a facility, with an estimated $10,000 to $60,000 cost per vacancy depending on the specificity of the nursing position” (Cleary & Rice, 2005). Cutting costs means we are sacrificing the care we provide to our patients. Purchasing cheaper equipment that is less reliable is sacrificial. Hiring fewer nurses to save money means higher nurse/patient ratios, and this can lead to missed diagnosis, healthcare acquired infections and workplace violence (Syed, L., Atif, B., Samreen, B., Zoya., & Saif, U., 2018).

Sadly, I often leave work wondering if I have done my best. I work on a renal, palliative and oncology unit. I am a resource nurse, but I also have a full patient module. I have had as many as 7 patients, run a unit of 28 patients, managed RRT’s and Code Blues and dealt with unhappy staff and patients all in one shift. Those are the days I ask myself, “why do I do this”? Those days are perfect examples of what leads to turnover. Cimiotti, Aiken, Sloane and Wu, summed it up perfectly: “Due to the decreased staffing of nurses, it is becoming more difficult for current active nurses to affectively provide quality patient care to their patients. If nurses are required to service more patients due to a lack of staffed nurses it has been shown to increase infection rates in hospitals” (Cimiotti, Aiken, Sloane, & Wu, 2012).

Studies indicate that turnover contributes to the nursing shortage but what are we doing about the issue? New Graduate Residency programs allow new nurses the opportunity to learn, grow and gain experience with a mentor. Nurse residency programs have been shown to improve retention through mentoring, education and experience (Ackerson & Stiles, 2018). Residency programs help new graduates find a position in an acute care environment. When I graduated from nursing school residency programs were not available. The only RN position I was able to find for the first two years of my career was in a long-term care facility. Out of 20 applications I filled out, 19 stated, “you do not have the required one year of experience”. A residency program allows new grads to bypass rejection due to lack of experience and obtain the experience in the environment they choose and enhances nurse retention at the same time.

Ackerson, K., & Stiles, K. (2018). Value of Nurse Residency Programs in Retaining New Graduate Nurses and Their Potential Effect on the Nursing Shortage. Retrieved from: https://doi.org/10.3928/00220124-20180517-09

Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nursing Staffing, Burnout, and Health Care-Associated Infection. American Journal of Infection Control, 40(6), 486490.

Coustasse, A., Cox, P., & Willis, W. (2014). The U.S. Nursing Shortage and Turnover Problem. Marshall University. Retrieved from: http://mds.marshall.edu/cgi/viewcontent.cgi?articl…

Cleary, B., & Rice, R. (2005). Nursing Workforce Development: Strategic State Initiatives. New York: Springer Publishing Company

Syed, L., Atif, B., Samreen, B., Zoya., & Saif, U. (2018) How Patient-Perpetrated Workplace Violence Leads to Turnover Intention Among Nurses: The Mediating Mechanism of Occupational Stress and Burnout, Journal of Aggression, Maltreatment & Trauma, 27:1, 96-118, DOI: 10.1080/10926771.2017.1410751

DQ5

One of the most predicted changes promised under healthcare reform is a greater allowance and accessibility to wellness and prevention programs. These programs have often been treated as a minimally important service of the insurance and provider industry. As more and more clinical studies are starting to disclose, many of the chronic conditions that require long term and acute care services can be prevented, managed, and even reversed through use of wellness and prevention programs. Florence Nightingale’s theory supports wellness by addressing the whole patient and affirming his or her positive qualities and strengths.