NURS 8100 Individual Right Versus the Collective Good

NURS 8100 Individual Right Versus the Collective Good

NURS 8100 Individual Right Versus the Collective Good

Patient acuity is rising while registered nurses (RNs) at the bedside are dwindling. The State of Texas nursing shortage is at an average of 11.06% of its registered nurse slots unfilled (Wieck, Oehler, Green, & Jordan, 2004). American Nurses Association (ANA) Principles for Nurse Staffing (1999) served as a framework for policy change. Nurse strategists undertook the challenge with the overall intent to provide excellent patient care.

An example to address nurse staffing and the ensuing problems is the California Staffing Ratio Law. Nurse-to-patient ratios (NPR) are a direct association between errors and the number of RNs. Moghri, Kokabisaghi, & Tabatabaee’s (2021) studies on NPR show that a high ratio affects the quality of treatment, increases adverse events, and raises the patient’s hospitalization period. It is a perfect example of the tension that significantly affects nurses’ individual rights and the collective good. Addressing the nursing shortage issues in health care institutions is both challenging and controversial. Suppose a patient’s prolonged hospitalization period can cost the hospital financial strains. Hospitals are businesses; the median length of stay was six days, the median total cost was $11,267, and the median cost per day was $1,772 (Study: Covid-19 hospitalization costs, outcomes in 2020 improved over time, 2022). Nevertheless, at what cost will it have on nurses’ rights?

Nurses are sworn to follow a set of ethics such as Beneficence & Nonmaleficence. While health care providers are obligated to help people in need, we must do not harm (Bodenheimer & Grumbach, 2009). Nurses are overworked and unable to provide good care for their patients and consequently consider leaving their jobs. The tension between ethical and legal consideration leave nurses in a dilemma. For example, a nurse will work overtime hours to help the hospital organization but is at risk of committing a medical error that can lead to legal consequences. Mandatory overtime laws prohibit healthcare facilities from requiring employees to work more than their regularly scheduled hours except during a health care disaster that increases the need for health care personnel unexpectedly (Bae & Brewer, 2010). On the other hand, hospitals are still experiencing staffing shortages to care for their patients.

Reference

  Bae, S.-H., & Brewer, C. (2010). Mandatory Overtime Regulations and Nurse Overtime. Policy, Politics, & Nursing Practice, 11(2), 99–107. https://doi.org/10.1177/1527154410382300

Bodenheimer, T., & Grumbach, K. (2009). Understanding Health Policy : A Clinical Approach: Vol. 5th ed. McGraw-Hill Professional.

Moghri, J., Kokabisaghi, F., & Tabatabaee, S. S. (2021). Nurse staffing norms in a hospital: Determining a golden standard using a new estimation method. International Journal of Healthcare Management, 14(4), 1367–1372. https://doi.org/10.1080/20479700.2020.1760586

Study: Covid-19 hospitalization costs, outcomes in 2020 improved over time. Texas A&M Today. (2022, January 3). Retrieved April 4, 2022, from https://today.tamu.edu/2022/01/03/study-covid-19-hospitalization-costs-outcomes-in-2020-improved-over-time/

Wieck, K. L., Oehler, T., Green, A., & Jordan, C. (2004). Safe Nurse Staffing: A Win-Win Collaboration Model for Influencing Health Policy. Policy, Politics, & Nursing Practice, 5(3), 160–166. https://doi.org/10.1177/1527154404266578

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Health Care Policy.

Covid-19 vaccine mandate for health care workers gained a lot of publicity towards the end of last year. It was very important to have a policy that would guide health care workers due to COVID-19 vaccine hesitancy that was rampant in all population sectors for different reasons. A regulation was established to ensure all staff who were eligible to receive a COVID-19 vaccine would do so by January of this year before providing any care or treatment (Centers for Medicare & Medicaid Services, 2021). It was the responsibility of companies especially skilled long-term care facilities to establish a policy that would ensure those who qualified to be exempted did so in alignment of the guidelines established by the federal laws.

Tension between Individual Rights and the Collective Good.

In the health care world, herd immunity has been promoted especially in community nursing. It is very important because with herd immunity not everybody but the majority of the people can receive vaccination that leads to immunity of a disease. This makes infection transmission to be unlikely leading to the entire population being protected. This would cover even those who are not eligible for vaccinations. It is therefore important for bedside staff to be vaccinated. However according to Farah, Breeher, Shah, Hainy, Tommaso  & Swift (2022), there are major  disparities in actual vaccination rates among different health care workers (HCWs). Advanced practice staff who spend the least amount of time with patients have statistically received the vaccines than nurses and support staff. The probability of an infected support staff spreading COVID-19 would likely be higher because the close proximity of proving care with activities of daily living like showers may not be completed with full personal protective equipment (PPE) in place.

There are  HCWs who are hesitant to receive the COVID-19 vaccine. Bellanti (2021), refers a delay in acceptance or outright refusal of vaccines as vaccine hesitancy. Those staff members who decline to receive the vaccine even when they are eligible to get it cannot work in some hospitals or nursing homes. This creates a further challenge with staff shortage already being a major concern.

It is an undeniable fact that every person has a right to choose what goes in their body but it would not be wise to put people at risk if it was avoidable. To decline to get a vaccine because of misinformation, fallacies, or myths is unfortunate. This is relevant to the COVID-19 vaccine.

Ethical and Legal Considerations of the Policy.

There are different factors that surround the mandate for COVID-19 vaccination policy among HCWs.  Perez, Paul, Raghuraman, Carter, Odibo,  Kelly & Foeller (2022), point out the nature of HCWs make them have a high occupational  risk for contracting and transmitting the COVID-19 infection after exposure. Legally and ethically it would therefore be fair to give them a priority to receive the vaccines first.

Getting to a point of herd immunity would also be critical. This is not achievable if the vaccine is not accessible on a global level. According to Hosseini (2021), one of challenges of COVID-19 vaccine is whether the manufactures of the vaccine can be forced to share information with competitors so that availability of the vaccine across the globe can be reached quickly. It would be ethically meaningful to look at infectious diseases as public rights instead of individual needs.

Education is key to knowledge. It is important to acknowledge vaccinations have been an important tool that has been used to contain some dangerous diseases in the past. According to Gurenlian,  Eldridge, Estrich,  Battrell,  Lynch,  Morrissey, Araujo, Vujicic & Mikkelsen (2022), it would be for the greater good to further educate HCWs on topics like virology and epidemiology.

Reference

Bellanti, J. A. (2021). COVID-19 vaccines and vaccine hesitancy: Role of the allergist/immunologist in promotion of vaccine acceptance. Allergy and Asthma Proceedings, 42(5), 386–394. https://doi.org/10.2500/aap.2021.42.210063

Centers for Medicare & Medicaid Services. (November, 2021). Biden-Harris Administration Issues Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers.https://www.cms.gov/newsroom/press-releases/biden-harris-administration-issues-emergency-regulation-requiring-covid-19-vaccination-health-care#:~:text=All%20eligible%20staff%20must%20have,beliefs%2C%20observances%2C%20or%20practices.

Farah, W., Breeher, L., Shah, V., Hainy, C., Tommaso, C. P., & Swift, M. D. (2022). Disparities in COVID-19 vaccine uptake among health care workers. Vaccine. https://doi.org/10.1016/j.vaccine.2022.03.045

Gurenlian, J. R., Eldridge, L. A., Estrich, C. G., Battrell, A., Lynch, A., Morrissey, R. W., Araujo, M. W. B., Vujicic, M., & Mikkelsen, M. (2022). COVID-19 Vaccine Intention and Hesitancy of Dental Hygienists in the United States. Journal of Dental Hygiene, 96(1), 5–16.

Hosseini, M.(2021). A Covid Competition Dilemma: Legal and Ethical Challenges Regarding the Covid-19 Vaccine Policies during and after the Crisis. Public Governance, Administration and Finances Law Review, 6(1), 51–63. https://doi.org/10.53116/pgaflr.2021.1.5

Perez, M. J., Paul, R., Raghuraman, N., Carter, E. B., Odibo, A. O., Kelly, J. C., & Foeller, M. E. (2022). Characterizing initial COVID-19 vaccine attitudes among pregnancy-capable healthcare workers. American Journal of Obstetrics & Gynecology MFM, 4(2). https://doi.org/10.1016/j.ajogmf.2021.100557

. Thanks for the insightful discussion. From your discussion, I have learned that Nurse-to-patient ratios (NPR) are a direct association between errors and the number of RNs. There is a direct correlation between nurse-to-patient ratios and the number of errors that occur in a hospital setting (Twigg et al., 2021). The lower the number of RNs on staff, the higher the likelihood of errors happening. This could be for a variety of reasons, including nurses being overworked and not able to give each patient the individualized care they need. When nurses are stretched too thin, they are more likely to make mistakes in the course of healthcare delivery. The California Staffing Ratio Law is a regulation that sets a maximum number of patients that can be assigned to each registered nurse in hospitals and skilled nursing facilities (Harrington et al., 2020). The law was passed in 1998 with the goal of ensuring that nurses have enough time to properly care for their patients. Under the law, hospitals are required to maintain a nurse-to-patient ratio of 1:5 for general medical/surgical units and 1:4 for intensive care units (Sharma & Rani, 2020). Skilled nursing facilities must maintain a ratio of 1:10. These ratios are based on the number of beds in the hospital or facility, not on the total number of patients.

References

Harrington, C., Dellefield, M. E., Halifax, E., Fleming, M. L., & Bakerjian, D. (2020). Appropriate nurse staffing levels for US nursing homes. Health services insights, 13, 1178632920934785. 10.4103/jfmpc.jfmpc_248_20

Sharma, S. K., & Rani, R. (2020). Nurse-to-patient ratio and nurse staffing norms for hospitals in India: a critical analysis of national benchmarks. Journal of family medicine and primary care, 9(6), 2631. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491754/ Twigg, D. E., Whitehead, L., Doleman, G., & El‐Zaemey, S. (2021). The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review. Journal of Advanced Nursing, 77(12), 4599-4611. https://doi.org/10.1111/jan.14909