NRS 493 During your practicum, determine what clinical problem or issue the organization is facing

During my practicum the clinical problem that my organization is facing is the overwhelming nurse shortage. This is one problem that I have personal experienced and has affected my overall mental and physical health. The reasons for this shortage include lack of educators, high turnover, and inequitable workforce distribution (Haddad et al, 2022). As time goes on, the population ages and increases as a whole which increases the need for health services which directly increases the need for personnel, especially nurses. Many of the disease and conditions that were previously incurable have now been able to be treated with new technology, medications, and clinical trials which calls for the need for an increased amount of personnel to look after the patients’ health. This causes hospitals to work overtime to try and combat the increase of both patients and diseases. It has become very apparent that there is a necessity of nurses after the COVID-19 pandemic which showed how severely unprepared the nation is in terms of healthcare when there was limited access to hospital beds, ventilators, protective gear, masks, hand sanitizer, other life saving machinery etc. The overall nurse shortage has become a phenomenon that has become increasingly prominent in society over time, and this is due to turnover and dissatisfaction. Nurse turnover is what occurs when a nurse leaves an organization either voluntarily or involuntarily for a variety of different reasons ranging from wanting to retire to finding better benefits at other facilities. Nurse turnover is one barrier because it disturbs the well-functioning systematic process of the hospital, and the major consequence is that there are more patients than personnel leading to burnout in nurses that remain who must take on double or more of the responsibilities which debilitates nurses from being able to carry out evidence-based practice due to lack of time and resources (Dewanto & Wardhani, 2018). This debilitates the overall patient care quality given in the organization. The shortage of nurses is ironically what causes even more shortage in nurses. The lack of staff causes nurses and other personnel to gain double and triple the amount of patients and work that they typically do which causes burnout, stress, and overall dissatisfaction of the job due to difficult working conditions. Furthermore, in many instances, long shift hours are extended due to a lack of personnel coming in to take the next shift which may be due to staff calling in sick due to emotional exhaustion and the overload of work which makes them not want to come in to work. This issue has personally impacted me because the overload of work leads to more chance of mistakes and complications like injury which overall decreases the quality of care given to the patient

Dewanto, A., & Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC nursing, 17(Suppl 2), 52. https://doi.org/10.1186/s12912-018-0317-8

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage . National Library of Medicine. Retrieved May 5, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK493175/

I have noticed several issues happening with the clinic I am doing my practicum is facing. These issues include how their medications are stored and administered and the lack of handwashing stands available outside treatment rooms.

Effective handwashing practice has been seen to reduce hospital-acquired infections such as Clostridium difficile, Methicillin-resistant Staphylococcus aureus (MRSA), and Catheter-associated urinary tract infection (CAUTI), to mention a few (Jayasree and Afzal, 2019). The lack of handwashing stands outside of treatment rooms in the clinic will reduce the tendency for staff to wash their hands and lead to increased HAIs among nurses, other staff, and patients.

In addition, a medication error is one of the issues, especially with vaccination in the clinic. Medication error is a pertinent issue that needs to be addressed because of its implication for patient health and nurses’ legal matters. In the USA, the medication error-related deaths have been more than the deaths related to car accidents, breast cancer, and human immunodeficiency virus (Shahrokhi et al. 2013). It was observed that the storage of medication in the clinic, coupled with other working environments, can lead to a high incidence of medication errors. The oral medicines and other topical medications are stored on shelves and manually labeled under each medication. Vaccines are also stored in a cooler cabinet where nurses handpick them. The possibility of a medicine missing together is high and can lead to medication error which will cause harm to patients and legal issues for nurses.

REFERENCES

Jayasree, T., & Afzal, M. (2019). Implementation of Infection Control Practices to Manage Hospital Acquired Infections. Journal of Pure & Applied Microbiology, 13(1), 591–597. https://doi-org.lopes.idm.oclc.org/10.22207/JPAM.13.1.68

Shahrokhi, A., Ebrahimpour, F., & Ghodousi, A. (2013). Factors effective on medication errors: A nursing view. Journal of research in pharmacy practice, 2(1), 18–23. https://doi.org/10.4103/2279-042X.114084

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I have identified several clinical issues at the rehabilitation hospital in which I am doing my practicum. Due to insurance companies denying appropriate patients’, coupled with administration watching their bottom line, patients are being admitted with significant comorbidities and are often not ready for rehab (Themes, 2017). This causes two significant issues which are patient safety and acute care transfers of patients within 48 hours of admission.

Patient safety is compromised when patients are not in the appropriate care setting. When things go wrong, the rehabilitation hospital is not equipped to handle acute situations and patients are at risk. For example, a patient may be admitted, post cardiac surgery, before blood pressures and fluid volumes are under control. Patient admits and upon initial assessment, patient is noticeably short of breath. The next morning, we end up sending the patient right back to the hospital for a Lasix drip due to fluid overload. In this instance, had the nurse overlooked the presenting symptoms this patient could have very well had a seriously grave outcome.

NRS 493 During your practicum, determine what clinical problem or issue the organization is facing

In addition to compromised patient safety, the rehab hospital ends up losing money in the end for acute care transfers of patients within 48 hours of admission. A reported 23.5% of Medicare patients discharged to rehabilitation facilities are readmitted to acute hospitals within 30 days resulting in an estimated $4.3 billion in excess costs (Axon, Gebregziabher, Craig, et al, 2015).

References

Axon, R. N., Gebregziabher, M., Craig, J., Zhang, J., Mauldin, P., & Moran, W. P. (2015). Frequency and Costs of Hospital Transfers for Ambulatory Sensitive Conditions. Am. J. Manag. Care, 21(1), 51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521764

Themes, U. (2017). Safety in the Rehabilitation Setting: A Nursing Perspective. Musculoskeletal Key. https://musculoskeletalkey.com/safety-in-the-rehabilitation-setting-a-nursing-perspective

I enjoyed reading your post. Patient safety is one issue that bears significant outcomes in all types of care settings. This is because lapses in patient safety have several adverse impacts on patient outcomes. First, poor patient safety will most definitely lead to adverse patient outcomes (Ead, 2017). Furthermore, the adverse outcomes experienced by patients are bound to lead to higher costs of care, which are most likely going to be insured by the facility. This contributes to the increasing cost of care in general. That said, it is imperative to ensure that these issues are addressed as soon as possible, in order to avoid the potential of leading to adverse patient outcomes. In your post, you aptly indicate that these patient safety issues eventually lead to the rehabilitation program losing money and this further justifies the need for urgent solutions.

One potential solution to this specific issue is to improve the competencies of nurses within the institution, or to have a strict admissibility criteria when it comes to patient admission. Improving nurse competencies will empower the nurses to deal with the safety issues that emerge due to the patients’ conditions. Alternatively, the rehab center on the other hand, can evaluate its competencies. This entails ascertaining what its staff can do, and what its personnel is incapable of handling and then only admitting patients that can be well taken care off given the personal competencies of available. Both of these solutions will significantly improve the institution’s safety profile and also limit the costs borne by the organization.

References

Ead H. (2017). Patient Safety Consultants-Adding to Patient Care or Overhead Costs?. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses, 32(3), 267–268. https://doi.org/10.1016/j.jopan.2017.01.008

Two problems that I have noticed at the facility that I am doing my practicum at, is shortage of staff and a decrease in the quality of care that the patients are receiving. Staffing is at an all times low. Some of the reasoning behind the shortage stems from High turnover rates due to over pressured employees. Employees are being faced with working multiple shifts. Which in terms places added stress and physical exertion on the body. The staff are leaving facilities and going to staffing agencies where increase wages are been offered. This problem is also stemming from a shortage of accessible registered or certified nursing staff in conjunction with sufficient teaching and education. Another reason is that Existing Unemployment benefits are deterring individuals due to Panic of developing COVID.

As a direct result of this patients are not being offered quality of care. Patients are receiving less this optimal care. When assessing reason and inhibition of overlooked nursing care, the best reliable judges of oversight errors consist of employment levels, work atmosphere, and interaction. According to the labor department Nursing home faculties are operating at a low level with less than 240,00 workers with the start of the pandemic. With President Biden nursing home reform plan, I pray that it can help with the existing problems.

References:

Haddad LM, Annamaraju P, Toney-Butler TJ. Nursing Shortage. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/

Galanis, P., Vraka, I., Fragkou, D., Bilali, A., & Kaitelidou, D. (2021). Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of advanced nursing, 77(8), 3286–3302. https://doi.org/10.1111/jan.14839

The heightened stress levels of today’s nurses are due to more than just the pandemic, more than just the need to make urgent life-altering decisions, and more than just working long hours. All of these things and more, combined, weigh on the shoulders of many RNs.

Ongoing budget tightening has led many healthcare facilities to cut staffing levels, leaving a significant imbalance in the workloads for remaining nursing staff. This has been especially true during the pandemic. Many hospital employees were asked to move from their usual departments and roles to assist with the intensive care of COVID-19 patients. Most nurses are dedicated to helping patients however they can; however, it’s stressful to be thrown into a new area of nursing on short notice—especially in an area as demanding as critical care.

In more ways than one, I believe that the issues you have pointed out are related. By this, I mean that the nursing shortage is likely to lead to reduced quality of patient care. This is manifested by the fact that nursing shortages are likely to lead to issues such burnout and fatigue (Haddad et al., 2022). Fatigue and burnout among nurses is bound to bring out errors in patient care and these errors include medication errors. This often creates a ripple effect and this is higher rates of morbidity and mortality. On the other hand nurses that are fatigued are likely to be less satisfied and this would affect their output with regards to patient care. In facilities with lower patient to nurse ratios, the patients experience lower rate of mortality and lower failure to rescue rates and these are factors that are also involved in addressing these issues.

On this note, it is important to identify some of the solutions that would address this issue and the first step entails looking at the landscape of the profession and determining what available solutions there are. At the moment, the most viable solution is the use of emigrant nurses. These are nurses that are sourced from other countries that have low rates of job availability of nurses, and thus, the demand for nurses is low. By sourcing for nurses from these jurisdictions, the facilities are likely to bolster their nurse to patient ratios. This ultimately leads to better patient care, and higher rates of positive patient outcomes.

References

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In StatPearls [Internet]. StatPearls Publishing.

Staff turnover is the clinical issue that the organization is dealing with. This is a leadership problem that can be solved. It applies to both nursing and ancillary personnel. Staff turnover can have serious consequences in the clinical setting. It is critical for a nurse in a leadership position to understand why turnover is so high and what the company (and personnel) can do to minimize, reduce, or eliminate turnover. Having new and in-training employees all the time makes it harder for the nurse to build relationships with the staff and have a stable group of peers to work with. Delegation and trust are two important aspects that emerge over time between the nurse and the ancillary personnel. It is often difficult for the nurse in charge to explain to patients why the turnover is the way it is. Patients rely on the clinic and its staff to keep them alive, and seeing new employees come and go is not conducive to a trustworthy, robust clinic.

“Evidence does exist giving a picture of multiple determinants of turnover in adult nursing, with – at the individual level – nurse stress and dissatisfaction being important factors, and – at the organizational level – managerial style and supervisory support factors holding the most weight,” according to the report (Halter et al., 2017). If these vital relationships do not establish, job satisfaction suffers, which contributes to an organization’s high turnover rate. When both nursing and ancillary personnel are dissatisfied, it can have a variety of consequences for the organization, the most important of which is the quality of patient care. A+ “The healthcare system suffers from a high turnover rate, particularly among nurses, which has a number of negative consequences. The primary impact is not on the company’s finances, but rather on the ability to meet patient needs and provide high-quality care ” (Van Staden, 2017). Coming up with a solution for an organization is based on the resources and leadership of each organization. Whatever the case may be, leadership must do all possible to retain highly trained, efficient, and dependable employees.

References:

Halter, M., Boiko, O., Pelone, F., Beighton, C., Harris, R., Gale, J., Gourlay, S. & Drennan, V. (2017). The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews. BMC Health Services Research, 17(1), 1–20. https://doi-org.lopes.idm.oclc.org/10.1186/s12913-017-2707-0

Van Staden, E. (2017). High staff turnover – can it be reduced? Professional Nursing Today, 21(4), 54–56.

NRS 493 During your practicum, determine what clinical problem or issue the organization is facing