Effect of Nursing Shortag.docx
- 1. Effect of Nursing Shortage and Turnover on In-Patients Running Head: PICOT STATEMENT PAPER 1 Effect of Nursing Shortage and Turnover on In-patients Nursing shortage and turnover is a serious problem experienced in the United States of America (USA) and the world at large. Many states in the USA have inadequate nurses which end up impairing the quality of service given to the patients especially in-patients. The few nurses available cannot completely meet the needs of the patients especially those who critically needs total care and attention. The few nurses available are usually stressed and in a hurry trying to care for a high number of patients which is usually impossible. This situations adds stress to them and increase their chances of quitting the job. Nurses play a pivotal role in caring for these patients especially the ones admitted in long term acute care facilities (LTAC) since they continuously monitor the patients in critical conditions and provide necessary treatments and medicine to save the lives of the patients (Stone et al., 2006). There are various reasons which can be associated with the nurses' shortage and turnover and these include inadequate nursing educators, inequitable distribution of nurses, high turnover rate and aging workforce to name but a few. These problems can be solved by investing in the development of nurses to make them happy and well
- 2. equipped with the knowledge and skills required to handle their tasks. This can be through training them regularly, giving them a chance to further their education as they work, paying them well and giving them appropriate compensations among other key strategies. PICOT Statement Considering the patients in long term care facilities, do effective investment in the development of nurses compared to the current standards of nurse staffing in the USA essential in improving the quality of care of the in-patients? Clinical problem The shortage and turnover of nurses is an issue that has raised a lot of concern as far as the health of the patients is concerned. This issue has resulted in long patients stay in hospitals, increased bloodstream infections and increased fatalities. The patients in acute long term care units require total attention and monitoring than any other patients requiring basic care. This is to ensure that their conditions are kept in control. In fact, one nurse should only handle three or four patients maximum because of the criticality of these patients. The inadequate of nurses in the section makes each nurse to handle more than five patients and this decreases the quality of care given to these patients and increases fatalities or longer stays. (Thompson et al., 2013). It is therefore vital for the government and healthcare departments to effectively invest in the development of nurses to increase their number, education, abilities, and motivation. There should be adequate schools and nursing educators to educate and train all the nursing students. As well, nurses should undergo regular training and education to ensure they have the necessary skills and education required in their work. They should be compensated properly and provided with a conducive working environment which will increase their working morale (Chandra, & Willis, 2005). Evidenced-based
- 3. Solution The evidence-based solution to increase the number of nurses and prevent their turnover is effectively investing in the development of nurses. Proper investment in the development of nurses includes increasing nurse educators, allowing nurses to further their education when they are still working, regularly training them, providing them with proper compensations to increase their motivation to work and ensuring there is a conducive working environment. These strategies will increase the number of nursing students, make nurses happy, motivated and comfortable when working and will, therefore, reduce their shortage and turnover. As a result, the quality of care given to in-patients will improve and the deaths, infections and longer stays of the patients will also decrease (Thompson et al., 2013). Nursing Intervention The role of nurses is very important when it comes to caring for in- patients. In fact, nurses are termed as “hearts and souls“ of the hospitals. They are referred to as patients advocates since they are the ones who spend most of the time with the patients. They are the ones who administers and evaluate the treatment
- 4. given to the patient. According to the research, nurses play an instrumental role in treating and following the patients to ensure that they are well and healthy and that their condition is in control (Butcher et al., 2018). They do research on the best practices for the patients and also educate the patients and their families on the ways to keep their conditions in control and live healthy lives. LTAC nurses continuously assess and monitor their in- patients to ensure that they provide quality and timely care to safeguard the lives of the patients. They can change treatments where necessary to better meet the requirements of the patients. LTAC is a demanding section and requires adequate nurses to effectively care for the patients. According to AACCN (American Association of Critical Nurses), each ICU nurse should only serve one or two patients (Nursing.com, 2018) this also goes for LTAC patients who are high acuity patients and also require a high level of care. Patient Care Patient’s families must be totally involved in the LTAC section as to be in a position to make important decisions pertaining to their family member admitted in LTAC especially the vent patients who do not have advanced directives. The patient’s families should be given the necessary education to ensure that they know the need for the provided treatments and interventions in helping their loved one(s) recover. The success
- 5. of the intervention will only be realized if the patient’s family comply with the medical guidelines and effectively collaborate with the nurses. The nurses regularly assess the patients to know whether to change or add additional treatments to improve patients care. Health Care Agency Vibra long term acute care care hospitals are out to ensure that patient live a healthy life. They carry out research regarding various illnesses and injuries all with the aim of ensuring that they provide quality care to the patients and help them recover. The success of the LTAC units is gauged using the rate of survival for the patients and their stay in the facility. The research conducted by the clinic shows that after admission to the LTAC, the patients should undergo physical and rehabilitation therapy and services to increase their chances of survival. The research also showed that early mobility services to the patients after going to the LTAC is vital in decreasing their stay, the cost of the care, patients and anxiety and as well improve their strength and functional abilities. The nurses in Vibra hospital collaboratively work together with the doctors and specialists in different areas such as speech, language, and respiratory therapies to ensure they provide the best care to the patients. In order to provide these patients with the best interventions, medical services, and therapies, nurses must be
- 6. adequate to properly meet these requirements. Nursing Practice It is the nurses’ responsibility to provide a safe, secure and conducive environment for the patients to ensure that they live healthy lives. As well, they should assist the patient’s family to understand their conditions and the importance of the provided medications, therapies and interventions (Maier-Lorentz, 2008). The nurses have a pivotal role in ensuring that the patients stay in the LTAC is reduced, reduce infections probable to the patients, reduce fatalities and as well help the patients recover and have a normal life. When the nurses effectively collaborate with the patient’s family and other care specialists, it will be possible to prevent deaths and minimize in-patients stay. Conclusion PICOT STATEMENT PAPER 2 The United States has a massive nursing shortage, and the
- 7. problem is only set to grow. Due to an influx of patients into our health system, the retirement of baby boomers, and educational bottlenecks, nursing positions aren’t being filled fast enough to keep up with demand ("Shocking Truth about the Nursing Shortage in the United States," 2018). Currently, Vibra hospital of Springfield is experiencing a high level of nursing shortage and turn over , this is hugely because of unstable patient census. When patient census decreases, nurses are being called off and this affects their pay checks seriously, when it persists for a long time some nurses can no longer handle it making them go seek employment elsewhere. When eventually patient census comes up like it has at the moment, there will not be enough nurses to take care of these patients adequately. Many at times the patient to nurse ratio goes up to 8:1 which makes it difficult to give these patients the best care they deserve. References Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. (2018). Nursing Interventions Classification (NIC)- E-Book. Elsevier Health Sciences. Chandra, A., & Willis, W. K. (2005). Importing nurses: Combating the nursing shortage in America. Hospital Topics, 83(2), 33-37. Maier-Lorentz, M. M. (2008). Transcultural nursing: Its importance in nursing practice. Journal of cultural diversity,
- 8. 15(1), 37-43. Nursing.com (2018). What Does an ICU Nurse Do? Retrieved from: https://www.bestmasterofscienceinnursing.com/faq/what- does-an-icu-nurse-do/ Stone, P. W., Larson, E. L., Mooney-Kane, C., Smolowitz, J., Lin, S. X., & Dick, A. W. (2006). Organizational climate and intensive care unit nurses’ intention to leave. Critical care medicine, 34(7), 1907-1912. The Shocking Truth about the Nursing Shortage in the United States (2018). Retrieved from https://getreferralmd.com/2017/12/on-the-verge-of-a-nursing- shortage/ Thompson, D. A., Hsu, Y. J., Chang, B. H., & Marsteller, J. A. (2013). Impact of nursing staffing on patient outcomes in the intensive care unit. Journal of Nursing Care, 2(128), 2167-1168. Running head: BENCHMARK CAPSTONE PROJECT CHANGE PROPOSAL1 BENCHMARK CAPSTONE PROJECT CHANGE PROPOSAL 2
- 9. Daily Chlorhexidine (CHG) Bath in Oncology Patients to Prevent Hospital Acquired Infections (HAIs) Daily Chlorhexidine (CHG) Bath in Oncology Patients to Prevent Hospital Acquired Infections (HAIs) HAIs are disease process developed by the patients during hospitalization. According to Centers for Disease Control and Prevention, (CDC), (n.d),” healthcare-associated infections are infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting”. Healthy People 2020, (2014) explained that “Modern healthcare employs many types of invasive devices and procedures to treat patients and to help them recover. Infections can be associated with procedures (like surgery) and the devices used in medical procedures, such as catheters or ventilators” HAI includes central-line-associated bloodstream infection (CLABIs), urinary tract infection (CAUTI), surgical site infection (SSI), ventilator-associated pneumonia (VAP), and the issues of multidrug-resistant organisms (MDRO), including methicillin- resistant staphylococcus aureus (MRSA), clostridium difficile infection, and vancomycin-resistant enterococcus (VRE)( CDC,
- 10. n.d). Background HAIs are significant precipitate of sickness and death in the United States and are linked to extensive surge in health care expenses each year. Every now and then, 1 out of every 25 patients admitted in the hospital are affected by HAI” (Health People 2020, 2014). According to Donskey and Deshpande, (2016), “Patients colonized or infected with health care- associated pathogens often carry the organisms on their skin. Such contamination may lead to infection when factors such as devices, catheters, and wounds provide a route for pathogens on skin to reach normally sterile sites. Additionally, Waknine, (2013) also stated that notwithstanding prevalent application of evidence-based practice, up to $9.8 billion is disbursed yearly for management of HAIs, hence infection from wound post operatively is the most expensive to treat. Nevertheless, skin infection can correspondingly be a contributory factor to the spread of pathogens because of environmental peeling and transference to the hands of employees. Consequently, there is a solid validation for efforts to diminish the problem of microorganism on skin (Donskey & Deshpande, 2016, P 17). Problem Statement Several studies on HAIs in United States (U.S) shows a rise in the infectious process leading to several diseases conditions that
- 11. escalates costs and secondary complications. It is predicated that up to 250,000 patients are infected with central line- associated blood stream infections (CLABSIs) every year. The expenses for treating individual CLABSI is projected to range from $16,000 to $29,000, resulting in an additional admission, and increases the probability of causing death by 35% (Pagan, 2017). CAUTI is also budgeted to be treated with up to $350 million (Saint, Gaies, Fowler, Harrod & Krein, 2014). Other studies noted varying burden of costs and related death rate that are applicable to other HAIs (VAP, SSI, BSI). Healthcare members are supposed to handle patients with central lines, ports, catheters, v ventilators with extreme caution, observing strict aseptic protocol when caring for them. HAIs arise when there is a breach in this protocol. Purpose of the Change Proposal Owing to the increase in the incidence of HAIs, in addition to the percentage of death caused by HAIs and the burden of cost they create with prolonged hospital stay, the writer planned to get to the root of the problem by conducting a study to recommend a change among oncology patients in writer’s unit. The recommendation for change is likely to enhance patients’ survival rate, prevent infection, reduce hospital stay as well as increase satisfaction and reduce costs. Additionally, recommendation for change is supposedly anticipated to help in educating the healthcare providers based on evidence-based
- 12. practices aimed to reduce/prevent HAIs by using chlorhexidine gluconate daily in bathing patients susceptible to HAIs. PICOT The utilization of the PICOT question formula has made the development of answerable research question easier and can be used to note if planned change actually occurred. The writer of this work used a PICOT declaration which was useful in the provision of positive rejoinders to the research question, “In Adult Oncology patients, does the use of Daily CHG bath compared to use of soap and water affect the incidence of HAI (CLABSI) throughout period of hospitalization. Literature Search Strategy Employed The writer of this work acknowledged EBP