Patient Workload on Nurses
The nursing career is among the most important professions in the world. There have been changes in the health care profession, which has an impact on the workload of the nurses, patient safety and the quality of care accorded. It is for this purpose that the chosen study topic is “Nurses Perception of Patient Workload on Nursing Effectiveness.” Whenever there is staff burnout in the vocation, it develops a critical problem as it is a human service profession. It leads to debilitation of workers, becomes expensive to agencies, and it is detrimental to the clients. Understanding the perception that nurses have towards patient workload is essential in identifying other factors affecting their effectiveness such as job stress. Therefore, the topic focuses on the nurses and their perception of the current situation on workload. If they consider that it is heavy, it may be affecting their output, which may be detrimental to the patients.
Justification for Topic Choice
As earlier stated, nursing is one of the most stressful professions. Job stress entails a psychological syndrome that an individual has in response to chronic exposure to interpersonal and emotional stressors while on the job. The psychological markers of stress sometimes may occur without an individual’s awareness of the demands of the environment. They include increased cardiovascular activity and heightened psychological arousal (Warner, 2014). Often, the environment at the healthcare facilities lacks adequate support staff, which may further contribute to the job’s stressful nature. The profession is also facing shortage of nurses. Analysis indicates that there may be a shortage in the workforce of the nurses in the future. As the baby boomers age, there will be increased demand for nurses due to the augmented need for healthcare. The current supply of nurses is from the registered nurses and the licensed practical nurses. There are various issues contributing to the nursing shortage. First, there is a shortage in the nursing school faculty, which is restricting the enrollment into the nursing profession (AACN, 2014). In 2012, the U.S. nursing schools turned away almost 80,000 qualified applicants who were interested in pursuing baccalaureate and graduate programs in nursing. The main reasons were insufficient faculty, classroom space, clinical sites, budget constraints, and clinical preceptors (AACN, 2014).
Second, there is a notable section of the nursing workforce that is nearing retirement. According to a 2013 survey, about fifty-five percent of registered nurses are aged 50 or older (AACN, 2013). In the next decade, more than one million nurses will retire. Third, there are changes in the demographic composition that is signaling the need for additional nurses. It is mainly due to the increasing aging population. The birthrate is reducing, which means that there will be fewer people to work as nurses as the current lot retires. Moreover, as the aged population increases, the demand for healthcare will increase. Fourth, studies have indicated that there is high-stress level in the profession due to insufficient staffing, which is affecting their satisfaction. As a result, many nurses are leaving the profession. It is also characteristic for nurses to change professions after a short period of service (AACN, 2014). The safety of patients and quality of the services that they receive is reliant on the satisfaction of the nurses. It is also reliant on the nurses’ ability to handle their workload efficiently.
When the number of nurses is not sufficient, the care and safety of patients may be compromised. At the same time, the nurses may be dissatisfied, overwhelmed and distressed. Increased nurse-patient ratio lead to frustration and job burnout, which is the key cause of turnover in the profession. When there is a shortage in the nurses’ workforces, it becomes necessary to develop strategies that will enable the rectification of the issue (AACN, 2014). It is also evident that the nurses’ shortage problem is not only an American problem, but also a global problem. Numerous countries are affected by the same problem, and finding the current situation is a step towards getting the solution. It is essential for the nurses operating in all institutional specialties, as well as, those in leadership and administrative positions to examine the factors contributing to the current shortage. In addition, there should be familiarization of the nurses to the situation and make a determination of what ought to be implemented in order to influence improvement strategies. Therefore, the choice of the topic will guide the study into identifying the situation in the nursing profession, and the perception that the nurses have towards their roles. Additionally, there will be an investigation of the patients’ situation due to the prevailing situation. In addition, the findings can be applied in the findings of a solution.
Importance of the Project to Nursing
Nursing course requires understanding the practical and theoretical issues relating to the profession. In addition, it is necessary to understand the actual environment. As the research indicates, a considerable number of nurses do not pursue the profession for more than two years after they start practicing (AACN, 2014). It means that they are usually unprepared for the actual work experience. Understanding how to become a nurse or the medical issues associated with it is important, but practicing is the ultimate goal. Therefore, loses its purpose to have a large number of qualified nurses who are not willing to practice. The project will assist in analyzing the situation from the nurses’ perspective. They will provide information that will assist students to understand the situation in the actual field and prepare for it. As the discipline entails different aspects of training, an additional reinforcement to the training can assist develop high-quality nurses who are prepared for the actual work is necessary. As a nurse, the main target is to become useful in the field. In addition, the discipline may not be highlighting different issues affecting the profession. For instance, there should be preparation for the students to work under pressure. The study will make recommendations to relevant authorities on the factors affecting the profession.
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The recommendations will include actions that need to be taken in the teaching. The current procedures used for teaching in health related fields are mainly student based. Most of the courses evaluate the teachers based on the evaluations made by students. The students have no field experience to understand whether whatever they learn is useful or important. The perspectives offered by the nurses will be useful in the development of curricula, which means that the students who go through it will be better prepared for their professional role. The recommendations will also provide the plight of the nurses, and through the nursing discipline, it can be possible to get relevant authorities responding to the problem. Therefore, the project is relevant to the nursing discipline as a whole.
In the recent years, there has been an increase in the demand for healthcare and nursing services. It has also attracted increased demand. It has become important to understand the workload that health providers have, and its impact on their delivery of service. Consequently, the closer examination of the issues has led to the need to examine the characteristics of the caregivers, as well as, the care provided. Increased pressure on the nurses due to their workload translates to low output or lower quality of service. As the current population of people ages, the demand for healthcare services will increase. It means that it would be necessary to have more nurses attending to the patients. Additionally, the general population in America, which is a developed country, is increasing at a slow pace. Therefore, there will be fewer people to take the current positions as nurses. The pressure is increasing as time moves, and it has become necessary to gather information regarding the perception of the nurses. While studying, nurses are trained to work under pressure. However, it is uncertain whether they can handle the pressure they get due to increased workload.
When working under pressure, human beings tend to produce low-quality results. When the nurses have to work extra hours, or attend to a larger number of patients, it means that there are getting immense pressure both physically and psychologically. Studying the human factors relating to nursing workload is vital, rather than considering the simple factors, such as, task performance, time needed for the accomplishment of roles, and skill competency. In addition, although other researchers have focused on the matter, it is essential to recognize the nurses’ perspective. If the workload increases, the nurses suffer from stress. The occupational stress will lead to decreased efficiency and increased hazardous within and without the hospitals. Among the different factors leading to absenteeism, job stress is ranked high. It also leads to absenteeism (Adib-Hajbagheri, Khamechian & Alavi, 2012). With the influence of other factors, having a large workload can affect the nurses negatively when at the place of work, besides, their private lives. Consequently, the services given to the patients are of lower quality. The problem relates to the identification of the perception that the nurses have towards patient workload, as well as, its effect on delivery of service. It is essential to understand these aspects in order to develop recommendations and suggestions that would promote the improvement of the situation.
As a result of the increased workload, there is a lack of sufficient time for a nurse to tackle various tasks. It has a direct impact on the patients. It can also impact negatively on the nurses’ decisions on the performance of various procedures. Nurse-patient communication is also affected by the time insufficiency. Increased workload has also led to decreased motivation for the nurses. Thus, the nurses’ turnover and absenteeism increase. There is also poor performance and reduced morale. It also leads to stress in the workplace, violation of rules and errors.
Over the past two decades, there have been numerous changes in the health service delivery. Different parties have made changes in relation to new sets of regulations by the government (Scott, Matthews & Kirwan, 2014). Consequently, the approach through which the nursing care is provided has changed. Earlier studies have focused on the concern of patient workload focusing on different variables. Such variables include staffing patterns, perception of patients, pattern of communication between different professions, and demands from the environment (Scott, Matthews & Kirwan, 2014). Such demands include the availability of supplies, which contribute the outcomes of the patients and quality of services. However, other aspects, such as, intellectual capital, contribution of nursing knowledge, and psychological workload should also be considered. Although it has been identified that the measures of nursing workload does not assure efficiency, and they lack to capture the complexity of the nursing workload, it is necessary to conduct such studies. The work environment variables have received little focus from studies relating to nursing workload (Scott, Matthews & Kirwan, 2014). However, that has been focus on factors such as the relationships of between employees and colleagues, as well as, their managers. It has been identified that work relationships have higher impact on the satisfaction of the nurses than economic variables. The effects of the workload on nurses have been witnessed not only in USA, but also in other countries throughout the globe.
The present trepidations regarding the effect of nurse staffing on the quality and safety of the patient services emanate from the merging of different factors. They include recurring shortages in the nurses’ workforce, measures to contain the costs in the 1990s, and increased concern by the public regarding the safety of the patients (AACN, 2014). Fewer patients per nurse increase the quality of care and safety of the patients. The presence of medical as a cause of deaths in the hospitals has also elicited pressure to understand whether staffing has an impact of the safety of the patients. It could be attributed to the nurses’ pressure or lack of concentration while offering services due to burnout. Nurses have also aired their perceptions regarding the re-engineering and redesign of their work. The concern of nurses relates to the increasing ratios of the patients to nurses, its impact on the welfare of the patients, and the substitution of unlicensed personnel.
Possible Causes of the Problem
The working population is aging at a high rate than the general population. Consequently, when nurses retire, there are no replacements available. A significant part of the current nurses in the workforce are nearing the retirement age, whereas few nurses are being employed. There is also a decrease in the nursing school faculty, which restricts the enrollment of nurses. It is mainly due to classroom space, clinical preceptors, and clinical sites. As the general population increases, there is an increased demand for the nursing services. Consequently, the pressure increases on the current workforce. The increased pressure and stress in the workforce have led to job dissatisfaction, and most of the nurses leave the vocation. As a result, the remaining nurses have to attend to a higher number of patients.
- Is there an increased workload in the profession according to the nurses?
- What is the impact of the current workload on the ability of nurses to offer services?
- What is the effect of the workload on the patients?
Impact of the Workload
There are different aspects relating to the dissatisfaction of patients due to the high workload on the nurses. Aalto, Karhe, Koivisto, & Valimaki (2009) study the connection between the nurse’s workload and the dissatisfaction of the patients. They found that the workload of the nurses varies depending on the flow and condition of the patients. They found a connection between high workload and dissatisfaction of the patient. Blay, Duffield & Gallagher (2012) focus on the transfer of patients due to workload on the nurses. When the patients have short stays, there is increased work to be done by the nurses. Additionally, there is increased risk of health-care acquired infections and incidents of medication. Bogossian, Winters-Chang, & Tuckett (2014) focus on the perception of nurses in relation to its contribution to abrasion in the nursing vocation. They found out that various factors including workload affect the perception of the practicing nurses towards the profession. Duffield et al. (2010) conduct a study on the different factors relating to the workforce and workload of the nurses. It became evident that the models of care are varied according to the circumstances in each of the wards, as well as, the levels of staffing.
Myny et al. (2011) conduct research and identify that there are different causes and effects of the impact level of workload pressure. They suggested that nursing workload has a multi-causal etiology, and the influencing factors can be integrated to for a workload measurement tool. A study conducted by Palese (2013) sought to conceptualize the impact of the daily intervention by nurses for the Italian patients. They found out that the nursing system has positive impacts on the safety of the patients, as well as, other multidisciplinary outcomes. The impact is in different levels including national and international. Donovan, Doody & Lyons (2013) focusing on stress as an important factor in the nursing profession. It has adverse impacts on both physical and emotional aspects of the nurses. Consequently, it reduces individuals’ ability to work as required. In the nursing profession, it has adversarial effects on the patients.
Measurement of the Workload
The assessment of the nursing workload requires the use of electronic sources of information. Baumberger & Hunstein (2009) focus on the use of data available in the electronic sources so as to assess the link between the nursing workload and the outcomes. They state that it increases the explanatory power of nursing data. Brito & Guirardello (2011) conducted a study relating to the workload on nurses relating to inpatients. They found out that the use of Nursing Activities Score (NAS) can assist in the evaluation of the workload of the nurses. Debergh et al. (2012) conduct a study on the measurement of workload in the intensive care unit. They found that the nursing activities score had been influenced by the characteristics of patients and shift type. Therefore, it is possible to measure the workload per shift. Fasoli & Haddock (2010) discuss the issues relating to systems of patient classification. They suggest that approaches used to predict staffing should be parsimonious and should minimize workload. They should also include the indicators used to measure the complexity of patients, resources available and organizational features. Hoi et al. (2010) suggested that in a rapidly changing nursing working environment, it is necessary to have frequent reviews of the workload measurement systems.
Jenkins & Welton (2014) indicate the importance of the standard measurement of the nursing cost for each patient. It could be benchmarked in all the hospitals so as to pass the information to all nursing administrators regarding the care delivery decisions. Kirby & Hurst (2014) indicated the importance of using a complex audit tool during the measuring of the workload, staffing, and quality of services in nursing facilities. It is a measure enable comparison of the factors, and their impact. Kohr, Hickey & Curley (2012) conduct research on different aspects of the synergy model during the making of nurse-patient assignments. They concluded that the synergy model is a prospective conceptual framework for a nursing productivity system. It may capture the researchers’ capacity to quantify the allocated resources. Kwiecien, Wujtewicz & Medrzycka-Dabrowska (2012) discuss the importance of the measurement of the workload. As one of the most frequently quoted factor in customer dissatisfaction, it is vital to measure it and respond accordingly. Mueller et al. (2010) conduct a study on the functioning of the patients as a predictor of the workload of the nurses. They found out that the in patients who suffered from cardiovascular and cardiopulmonary conditions selected similar responses, while those with muscular skeletal conditions gave different response. Therefore, they concluded that selected categories of scores could be used to measure workload in relation to different rehabilitative needs of patients.
Rossetti, Gaidzinski & Bracco (2014), conduct a study to identify the different indicators of the needed nursing workload in the emergency department for pediatric patients. They found a nurse – patient ratio of 1:2.6. They concluded that the application of a standard classification instrument was satisfactory. Sawatzky-Dickson & Bodnaryk (2009) studied the dependability and legitimacy of the Winnipeg Assessment of Neonatal Nursing Needs Tool. They concluded that it provided a reliable estimation regarding the number of nurses needed for a certain collection of patients so as to provide quality care. They recommended that nurse managers should incorporate it to determine the extra drivers that ought to be considered for the nurses in regard to time.
Solutions to the Workload Problem
Brann & Gustavson (2013) conduct a study on the issues relating to the problem of workload in the nursing profession. They suggest that controlling the workload will depend on maintenance of fiscal responsibility. It also requires the analysis of the work environment to ensure that nurses receive adequate support from other staff and they have a good relationship. Ellis (2013) conducted a study relating to the policies relating to the workload in the nursing faculty. The results indicated that about 12 credit hours are given to the concept of the workload per semester. They suggested that an increase on the time and components should be considered. Garcia (2013), suggest some features that should be included in the acuity system. The features include reliability and objectivity, validity, patient-centered, inclusive, efficiency, alignment, predictive, informative, actionable, and outcome driven. Keleher et al. (2009) focus on the importance of focusing on issues affecting the nurses. They state that nurses are effective in care giving in different roles. Therefore, their condition ought to be considered and improved.
Sundaramoorthi et al. (2010) suggest the use of two policies to make the nurse – patient assignments during the admission of new patients. They are the heuristic (HEU) policy and the partially-optimized (OPT) policy. The HEU policy assigns a new patient to a nurse who has performed least direct care among available nurses. The OPT policy seeks to lessen the variation among nurses for an entire shift through the estimation of assigned direct care. Welton (2014) suggest issues relating to the importance of the development of an advanced nursing care delivery system. He suggests the application of information acquired in the management of businesses. Therefore, hospitals should use electronic approaches in scheduling, staffing and setting of assignments. It will assist in the minimization of the heavy workloads and pressure on nurses; hence, improving their output. Measures that will lead to a minimization in the number of patients that each nurse should serve ought to be applied. In a study conducted by Magalhaes, Dall’Agnol & Marck (2013), they found a link between the safety of patients and the workload on nurses. Fewer patients per nurse ought to be the target as it improves restorative thinking. It also allows communication and personal relationships between the nurses and the patients.
The literature has provided essential information relating to previous studies on the research topic. The topic relates to the identification of the perspective of nurses on pressure emanating from the heavy workload, and its impact on patients. The literature review has provided possible impacts of the problem, measurement procedures and possible solutions. All the information is essential in the conduction of the research. It sets the foundation of what to be expected during the study. The measurements suggested by different authors will be essential in the collection of information for the project. In addition, the literature will assist in the analysis of the findings. It will act as a basis for comparison between the current issues and what is available in literature.