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This paper discusses four challenges nurses currently face in care delivery. These challenges include staffing shortages, workplace violence, long working hours, and workplace hazards. Included in this paper are ways to triumph over these obstacles. Also discussed is one key message from the Institute of Medicine’s (IOM) 2010 Future of Nursing report, nurses should attain higher levels of education and training via an enhanced education system that encourages smooth academic advancement. This paper also addresses the IOM’s five core competencies, how nursing practice can meet each, obstructions for each competency, and how they can be conquered.
Short staffing, or a low nurse-patient ratio, is a challenge in care delivery many nurses deal with in many specialties and environments. Short staffing may be due to many circumstances, including cost-cutting by the administration, the inability of non-citizens to be hired due to immigration issues, the general shortage of registered nurses, and nursing school enrollment (Pate, 2018). Short staffing negatively affects patient outcomes and quality of care, including more hospitalizations and readmissions. Lower nurse retention rates are also seen (Pate, 2018). During times of short staffing, nurses may try working above their scope of practice, which puts everyone, including the institution, at risk. Organizations may also be held accountable for injuries to patients due to short staffing. There are several ways to triumph, or at least handle staff shortages, as this is not a challenge with an easy or immediate resolution. California is currently the only state which mandates nurse-patient ratios. Seven states presently have laws regarding safe staffing levels.
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These states are Ohio, Nevada, Connecticut, Oregon, Texas, Illinois, and Washington (Pate, 2018). If short staffing is noted, notify the administration or a manager to determine the level of patient care needed to secure patient safety. It is vital during callouts to keep the level of staff with the same credentials equal. For example, if a registered nurse (RN) calls out, do not replace them with a licensed practical nurse (LPN). Supervisors must ensure staff are aware of their scope of practice limitations and not exceed them. Joint Commission (TJC) accredited facilities must determine staffing based on experience and internal statistics. The American Nurses Association (ANA) also has a nurse staffing model that organizations may follow. Since cost is one reason for staff shortages, another possible way to overcome this challenge is to link nursing care with reimbursement. Medicare and private insurance companies would pay organizations for nursing time and costs, apart from room and board (Pate, 2018)?
Workplace violence directed at nurses is a challenge nurses face in care delivery. It is a growing problem in healthcare overall, with 76% of nurses in one survey stating they had encountered violence within the last year (Hester et al., 2016). Per the Occupational Safety & Health Administration (OSHA), workplace violence includes threatening conduct, coercion, physical violence, and badgering. Violence can be anything from verbal abuse all the way to murder. All healthcare workers face risk, but nurses are at the greatest risk due to providing direct patient care and spending large amounts of time with the patient and family (Hester et al., 2016). Continual underreporting of workplace violence complicates the issue further. There are many causes for underreporting. Most often, it is not reported because violence may be considered part of the job. Nurses may also fear retaliation from the workplace itself. To face this challenge, nurses have several courses of action and options. There are multiple states with laws and stricter penalties, from misdemeanors to felonies, in place for violence against healthcare workers (Hester et al., 2016).
The ANA continues with a zero-tolerance stance on healthcare workplace violence. They recommend nurses remain conscious of their interactions. THC states the organizational culture must be one of safety and quality, developed and sustained by leadership. Nurses should take part in workplace prevention projects and keep abreast of hospital policies and procedures (Hester et al., 2016). Nurses must also report any incidence of workplace violence or any perceived breakdown regarding weaknesses in the plan if an incident does occur to them. A nurse may utilize counseling services to decrease the psychological effects. If it occurs to another, the nurse may offer referral services and offer support (Hester et al., 2016).
Long working hours are an additional challenge nurses face today in care delivery. Long hours have an effect on the individual nurse and on patient safety, including nurse fatigue, errors, and workplace injuries (Ulrich, 2018). Long working hours also include working several days consecutively or vigorous shifts with too infrequent relief. On-call hours are a significant concern, with many nurses working their call shift and regular shift successively. This may lead to over 30 hours worked in a row. In 2011, TJC issued a Sentinel Event Alert. This Alert stated that tiredness increases the likelihood of unfavorable occurrences, lowers standards for patient safety, and escalates danger to individual safety and welfare (Ulrich, 2018). One way to overcome this challenge is for nurses and organizations to work together on solutions that safeguard nurses from this. Another way to conquer this challenge is to become informed on evidence regarding nurse tiredness and a way to combat it (Ulrich, 2018). It is important to ask the right questions when developing a plan, such as what are called nurse hours and how often are they called in? How long is the entire shift? How many successive hours and days are they expected to work? The answers to these questions will assist in implementing a plan (Ulrich, 2018).
Workplace hazards, specifically workplace injuries, are another challenge nurses face today in care delivery. Work-related back injuries cause approximately 12% of RNs to depart from the profession per year (Rogers et al., 2013). In a 2011 ANA survey, over 60% of those who responded named incapacitating work-related musculoskeletal injuries as their second biggest concern. Many reported working despite having frequent musculoskeletal discomfort. Healthcare workers suffer musculoskeletal injuries injures at a rate of seven times the average of all other occupations. RNs lose anywhere from 6 to 14 days from work due to each injury, depending on the age of the nurse (Rogers et al., 2013). Injuries occur because of heavy pulling and pushing, working in cumbersome positions, and repositioning patients. The danger is amplified by more patients becoming obese and getting older. As such, lessening and avoiding back injuries is crucial to maintaining the health of nurses. These injuries negatively affect staffing levels, balance of experience, and care of patients.
This includes patient outcomes (Rogers et al., 2013). To overcome this challenge, several strategies have been found to be helpful. Establishing a hospital nursing lift team program may assist with moving heavy patients. These teams may help decrease the number of injuries and days lost from work. Another way to overcome this challenge is the use of mechanical lifts. Unfortunately, many times these are not used because they are burdensome. Implementing an extensive training program in the use of these devices is vital to the success of their use. An additional strategy to overcome this challenge is an assorted intervention, which includes various protocols and policies such as ergonomics assessment and no manual lift, peer safety leaders, and more (Rogers et al., 2013).
Organizations that implemented these changes saw their employees with fewer rates of work-related injuries and callouts and higher employee and patient contentment. Staff recruitment and retention also increased.
One of the key messages from the Institute of Medicine’s (IOM) 2010 Future of Nursing report is nurses should attain higher levels of education and training via an enhanced education system that encourages smooth academic advancement. The IOM report advocates that by 2020, the number of baccalaureate (BSN) prepared RNs should increase by 80%, and the number of doctorate-prepared RNs should increase by 50% (Chard, 2013). Unlike other healthcare professions, there are several modes of entry into nursing practice. These include diploma, associate degree programs, and baccalaureate degree programs. This report compels schools of nursing to advance the academic preparation of nurses. The report outlines the goal is to develop a vigorous, diversified, and educated nursing workforce (Chard, 2013). There are now almost 700 RN to BSN programs (Moody et al., 2018).
This message is important to the nursing profession for several reasons. BSN-prepared nurses may have a widened scope of practice by leaning on education for evidence-based practice, leadership, and community health. Increasing a nurse’s education advances their professional development and equips them to undertake important matters affecting healthcare (Moody et al., 2018). Improved patient outcomes are associated with nurses who are educated at the BSN or higher level (Haverkamp & Ball, 2013). BSN-prepared nurses also exhibit a better understanding of the professional role and improved decision-making and communication skills. Per the National League of Nursing, academic development will assist the profession to work successfully in conditions that include higher patient acuity, shorter length of stays, fast technological changes, growth of drug options, and more patients who are older with chronic medical illnesses (Haverkamp & Ball, 2013).
The IOM’s five core competencies include providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics (Institute of Medicine, 2003). Ways in which nursing practice can provide patient-centered care include recognizing, regarding, and tending to patients’ dissimilarities, morals, inclinations, and stated desires. It is also important to alleviate suffering and discomfort and provide seamless care. It is vital to listen and communicate clearly with patients. Patients must be part of the decision-making and management of their care. Ongoing patient education and advocacy regarding disease prevention and health promotion are essential (Institute of Medicine, 2003). Obstacles to providing patient-centered care include changing diversity and variations in nursing education and training programs. Solutions to these barriers include developing systems of care specific to a population and educating all healthcare professionals to provide patient-centered care (Institute of Medicine, 2003). The nursing practice may be seen at work in interdisciplinary teams. Interdisciplinary teams are comprised of various occupations, professions, and skill levels.
These teams combine their impressions and expertise to develop best practice models at their organizations. Some obstacles to interdisciplinary teams include team member resistance and uncertainty of roles. To assist in resolving these obstacles, it is vital to communicate with all team members, even if everyone is not in the same physical location, and comprehend individual roles (Institute of Medicine, 2003). Nursing can employ evidence-based practice to avoid the overuse, misuse, and underuse of care. Knowing where and how to locate evidence is critical. An obstacle to employing evidence-based practice is that many research studies do not include nursing interventions. One solution to this would be to standardize evidence, incorporating it with other research (Institute of Medicine, 2003).
The nursing practice may apply quality improvement by recognizing mistakes and dangers in care, simplifying and standardizing care, and measuring outcomes. One obstacle to quality improvement is long wait times for the results of tests. A solution for this would be to evaluate a more expedited process at another location and discover methods of improvement (Institute of Medicine, 2003). The nursing practice may utilize informatics in many ways, such as communication, overseeing information, and determining resolutions. One obstacle to utilizing informatics is a lack of knowledge. Few nursing schools include informatics in their curriculum. A remedy would include a disciple-specific competency based on the area of specialty and education level (Institute of Medicine, 2003).
There are many challenges nurses face today in care delivery. By being creative, tenacious, and working together, these challenges may diminish. Nurses attaining higher levels of education has been shown to have many positives for the profession as well as patients. The five core competencies describe various ways to improve the overall quality of patient care and education of healthcare professionals.
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