Add a section to the paper you submitted in Module 1. The new section should address the following:

Identify and describe at least two competing needs: (nurse shortage/workload and safe patient care) impacting your selected healthcare issue/stressor.
Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor.
Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics.
Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples.
Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations.

Effect of Nurses Workload and Staff Shortages

 Marie Moore

College of Nursing, Walden University

NURS 6053: Interprofessional Organizational and System Leadership

Dr.  Sandra Siedlecki

Nurses Workload and Shortages

Leaders of healthcare organizations must ensure appropriate staffing within their settings to be able to achieve their objectives. Their focus should be to achieve the Quadruple Aim that emphasizes the need to lower costs, improve patient experience, improve clinician experience, and achieve better outcomes (Arnetz et al., 2020). Stressors in healthcare systems are preventing many healthcare organizations today from fulfilling their mission, vision, and goals. Identifying these stressors early enough can help leaders of healthcare organizations to identify and implement corrective measures early enough before negative consequences occur. The purpose of this white paper is to help the leadership team to understand how nurses’ workload and shortages are affecting the work setting and evidence-based proposals to consider addressing the issue.

A Description of the Healthcare Issue or Stressor

Nurses’ workload and shortages are among the issues that the organization’s leadership should address to meet the rising healthcare demands, especially during the coronavirus disease 2019 (COVID-19) pandemic. Massive retirement among older nurses, excessive stress, increasing workload, and high nurse turnover rates caused by the pandemic have resulted in nurse shortage and increasing nursing workload across healthcare organizations nationally. A study conducted in a practice setting in Taiwan by Zhang et al. (2021) revealed that the COVID-19 pandemic influenced nurses to quit their nursing jobs. About 71.9% of the nurses felt that they were exposed to the virus at their place of work, approximately 49.9% reported increased workload, and about 7.6% considered resigning from their job. The pandemic also affected the nurses’ psychological well-being forcing them to leave their organizations (Shan et al., 2021). The available patient care needs at the time of the pandemic have become overwhelming for the few remaining nurses and this impacts negatively on patient outcomes, clinician experiences, healthcare costs, and patient satisfaction.

Impacts of the Issue or Stressor on the Organization

The facility has been recording poor performance since the pandemic ensued due to nurses’ workload and shortages. The stressors have compromised patient safety and healthcare quality at the facility. For example, as opposed to the rates before the COVID-19 pandemic, the organization is now recording between 5 and 10 cases of healthcare-associated infections every month. Findings from a study conducted by Shang et al. (2019) indicated that patients in units that are understaffed in both day and night shifts are likely to develop healthcare-associated infections 2 days after admission. Healthcare-associated infections contribute to prolonged length of hospital stay which increases the economic burden for both patients and the organization. For example, ward expenditures have risen by more than 5% in the past 1 year since the pandemic struck. Besides, increasing workloads prevent nurses at the facility from performing their roles effectively, a factor that leads to excessive stress, burnout, and negative psychological well-being. The facility will continue to record poor quality and safety scores when it does not address the problems of nurses’ workload and shortages.

Summary of the Two Articles

Evidence presented in the literature supports the effectiveness of numerous strategies that healthcare organizations can implement to address nurses’ workload and shortages. For instance, Griffiths et al. (2021) conducted a study to examine the effectiveness of flexible staffing options in addressing burnout and staff shortages in healthcare settings. The researchers discovered that the use of temporary nurse staffing option allows organizations to deploy nurses based on need, a factor that helps to improve patient outcomes. However, the two main advantages of using flexible staffing options include the high costs involved and the likelihood of not getting nurses to deploy on short notice. In another study, Sangal et al. (2021) examined the effects of leadership communication on workload, burnout, and stress among frontline healthcare workers in the emergency department during the COVID-19 pandemic. Findings from the study showed that effective leadership communication encouraged sharing of ideas on how to address workload and caused high perception of support among nurses thereby reducing stress and burnout.

How the Issue is Being Addressed by Other Health Organizations

Healthcare organizations implement varied strategies to address nurses’ workload and shortages during the COVID-19 pandemic. For instance, the Mayo Clinic Health System responded to nurses’ concerns during the pandemic by offering financial incentives and premiums, deploying agency nurses, and moving staff from outpatient units to inpatient units to minimize workload and improve staffing (Rinehart, 2022). Besides, radiology departments across various health settings in the United States re-organized their operations and personnel to manage the workloads and staff shortages caused by the COVID-19 pandemic (Xu et al., 2021). Other healthcare organizations can consider these strategies to ensure constant healthcare access for patients during the pandemic.

Strategies to Address the Organizational Impact Caused by the Issue and How they Might Impact the Organization

To conclude, the facility can implement the strategies outlined in the reviewed articles to address nurses’ workload and shortages. The interventions proposed in the articles include the use of temporary nurses to be deployed at the time of need (Griffiths et al., 2021) and the use of leadership communication to allow sharing of ideas and to reduce psychological stress (Sangal et al., 2021). These interventions might impact the organization positively by encouraging nurses’ retention, improving patient outcomes, promoting clinician experience, enhancing patient satisfaction, and minimizing costs (Griffiths et al., 2021). However, the use of temporary nurse staffing options may increase the likelihood of not getting nurses to deploy on short notice.

References

Arnetz, B. B., Goetz, C. M., Arnetz, J. E., Sudan, S., vanSchagen, J., Piersma, K., & Reyelts, F. (2020). Enhancing healthcare efficiency to achieve the Quadruple Aim: an exploratory study. BMC Research Notes, 13(1), 362. https://doi.org/10.1186/s13104-020-05199-8

Griffiths, P., Saville, C., Ball, J. E., Jones, J., Monks, T., & Safer Nursing Care Tool study team. (2021). Beyond ratios – flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study. International Journal of Nursing Studies, 117, 103901. https://doi.org/10.1016/j.ijnurstu.2021.103901

Rinehart, J. (2022). Nurses demand Mayo Clinic Health System address staff shortages, sacrifices. https://www.keyc.com/2022/01/19/nurses-demand-mayo-clinic-health-system-take-action-address-staff-shortages-sacrifices/

Sangal, R. B., Bray, A., Reid, E., Ulrich, A., Liebhardt, B., Venkatesh, A. K., & King, M. (2021). Leadership communication, stress, and burnout among frontline emergency department staff amid the COVID-19 pandemic: A mixed methods approach. Healthcare (Amsterdam, Netherlands), 9(4), 100577. https://doi.org/10.1016/j.hjdsi.2021.100577

Shan, Y., Shang, J., Yan, Y., Lu, G., Hu, D., & Ye, X. (2021). Mental workload of frontline nurses aiding in the COVID-19 pandemic: A latent profile analysis. Journal of Advanced Nursing, 77(5), 2374–2385. https://doi.org/10.1111/jan.14769.

Xu, Y., Mandal, I., Lam, S., Troumpoukis, N., Uberoi, R., Sabharwal, T., & Makris, G. C. (2021). Impact of the COVID-19 pandemic on interventional radiology services across the world. Clinical Radiology, 76(8), 621–625. https://doi.org/10.1016/j.crad.2021.05.001

Zhang, M., Zhang, P., Liu, Y., Wang, H., Hu, K., & Du, M. (2021). Influence of perceived stress and workload on work engagement in front-line nurses during COVID-19 pandemic. Journal of Clinical Nursing, 30(11-12), 1584–1595. https://doi.org/10.1111/jocn.15707.

Effects of Nurses Workload/shortage and Safe Patient Care/handling

Two Competing Needs Related to Nurses’ Workload and Shortages

Competing needs within a healthcare organization can prevent it from meeting all the requirements necessary for maintaining the desired quality standards. In an organization where nurses’ workload and shortages are the main stressors, the two competing needs related to the organization are; the need to improve clinician experience by eliminating workload and the need to maintain safe patient care (Sharifi et al., 2020). The organization is faced with the challenge of creating a balance between these two competing needs amidst the operational challenges caused by the COVID-19 pandemic.

Organizational Policies that May Influence Nurses’ Workload and Shortages

            The organization has developed a health policy that it is currently using to address the problem of nurses’ workload and shortage. The facility is using an on-call policy to support the remaining staff to handle the existing workload and meet changing healthcare needs. Under its on-call policy, the organization employs flexible staffing approaches where temporary staff stay at home and are called upon when they are required to handle emergencies outside working hours (London School of Hygiene & Tropical Medicine, 2017).

Ethical Considerations of the Policy, Including Its Strengths and Challenges in Promoting Ethic

Healthcare organizations should make appropriate ethical considerations whenever they are developing policies to address potential stressors. The on-call policy currently used by the organization is unethical in that it denies nurses the freedom to choose the most appropriate hours to work. They are unable to develop daily plans of activities and might be forced to work under pressure in times of crisis and during odd hours (Morley et al., 2020). Although the primary strength of the policy is that it allows the organization to minimize harm for patients, it does not promote ethics for the nursing staff that are hired under the on-call policy.

Recommendations

            The best recommendation for the organization is to utilize a permanent staffing policy. When it employs permanent staff, the facility will be able to balance the competing needs of resources, employees, and patients while also addressing the ethical challenges caused by the current on-call policy (Saville et al., 2021). For example, permanent nurses will be prepared whenever they are on duty to provide care to patients, thereby addressing the uncertainties caused by temporary staffing.

References

London School of Hygiene & Tropical Medicine. (2017). On-call policy and procedure for professional support staff. https://www.lshtm.ac.uk/sites/default/files/On_Call_Policy_PSP_Policy_Procedure.pdf

Morley, G., Grady, C., McCarthy, J., & Ulrich, C. M. (2020). Covid-19: Ethical challenges for nurses. The Hastings Center Report, 50(3), 35–39. https://doi.org/10.1002/hast.1110

Saville, C., Monks, T., Griffiths, P., & Ball, J. E. (2021). Costs and consequences of using average demand to plan baseline nurse staffing levels: a computer simulation study. BMJ Quality & Safety, 30(1), 7–16. https://doi.org/10.1136/bmjqs-2019-010569

Sharifi, M., Asadi-Pooya, A. A., & Mousavi-Roknabadi, R. S. (2020). Burnout among healthcare providers of COVID-19: a systematic review of epidemiology and recommendations. Archives of Academic Emergency Medicine, 9(1), e7. https://doi.org/10.22037/aaem.v9i1.1004