Week 3 Discussion
Healthcare is an industry set forth to care for patients but also to bring in revenue. An example of competing needs in healthcare is the organization’s fiscal need to make money and the nurse’s need to fulfill their values while caring for patients. Healthcare facilities have faced fiscal pressures for years (Manzano García & Ayala Calvo, 2020). We cannot leave out the fact that though we are in this profession to care for people, it takes money to make things work. Healthcare organizations have changed from a treat-heal-care model to a business model over the past few decades, with focus changing from patient outcomes to efficiencies and cost (Kelly & Porr, 2018). When we shift our focus primarily on the fiscal portion of healthcare, the values of providing optimal and competent health care are eventually lost. This can create an internal discord for nurses.
An example regarding the burnout and Covid-19 pandemic at my organization focuses on supplies. The nurses have had to fight for proper Personal Protective Equipment (PPE) since the start of the pandemic. Job resources are necessary to achieve desired work objectives (Janeway, 2020) We have been taught best-practice standards as nurses for infection control measures, however, we were now being told the bar is much lower than previously stressed. For example, prior to the Pandemic, we would never be able to re-use a single-use mask, but now staff is being asked to store their assigned N95 masks in a paper bag labeled with their name for repeated use. The bags are to be kept locked in another room down the hall from the nurse’s station where a dehumidifier is to be checked and emptied so the integrity of the masks will not be compromised. Any additional supplies are now under lock and key, and we must go through the Officer of the Day to get additional masks. We all know it is unsafe to reuse single-use masks and increases the chance to spread infection.
The impact this poor handling of the Pandemic has had on the organization is the loss of nursing staff. Many nurses walked away and now they are scrambling to find the staff to fill their places. The remaining nurses must work mandatory overtime to fill the staffing needs. We all know this practice will only increase the risk of burnout. They even went so far as to remove the one night nurse at the 300-bed facility due to staffing shortages. We know that is a dangerous practice. After much fighting, the one night nurse was brought back. Also, a reusable respirator was bought for the nurses, reducing the need to re-use masks. But, the fight continues as management continues to try to enforce unsafe practices and nurses continue to stand up for what is right.
Algunmeeyn, A., El-Dahiyat, F., Altakhineh, M., Azab, M., & Babar, Z.-U. (2020). Understanding the factors influencing healthcare providers’ burnout during the outbreak of covid-19 in jordanian hospitals. Journal of Pharmaceutical Policy and Practice, 13(1). Retrieved December 2, 2020, from https://doi.org/10.1186/s40545-020-00262-y
Janeway, D. (2020). The role of psychiatry in treating burnout among nurses during the covid-19 pandemic. Journal of Radiology Nursing, 39(3), 176–178. Retrieved December 11, 2020, from https://doi.org/10.1016/j.jradnu.2020.06.004
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1). Retrieved December 14, 2020, from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
I feel the frustration when I read posts like yours. Thank you for sharing the struggles; it makes me feel less alone when I read about other facilities’ challenges. I was reading about the psychological effects of this pandemic, and it makes me so sad. As humans, we can flex and adapt, as shown after 9/11, where the distress was heightened, but the symptoms grew less as the months passed (Miller, 2020). The terrorist attacks were a single event, and this pandemic has been a prolonged crisis for which adaptation can be difficult. However, if we look at the historical data in times of war, people do find a way to survive and function. And this is the mindset we need moving forward.
I do not think any of us were prepared for this to last as long as it has. As shared in Jackson et al. (2020), nurses were caught up in this pandemic and a moral crisis. We desire to help others, yet the inability to save so many has taken a toll on us emotionally and physically (Jackson et al., 2020). When we compound this with other obstacles such as short staffing and lack of PPE, it is overwhelming. As the backbone of healthcare, I hope nurses can come out of this pandemic stronger to face future challenges.
Jackson, D., Bradbury‐Jones, C., Baptiste, D., Gelling, L., Morin, K., Neville, S. and Smith, G.D. (2020). Life in the pandemic: Some reflections on nursing in the context of COVID‐19. J Clin Nurs, 29, 2041-2043. https://doi-org.ezp.waldenulibrary.org/10.1111/jocn.15257
Miller, E. (2020). The COVID-19 pandemic crisis: The loss and trauma event of our time. Journal of Loss and Trauma, 25(6-7), 560-572, DOI: 10.1080/15325024.2020.1759217
Discussion: Organizational Policies and Practices to Support Healthcare Issues
Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.
For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?
In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.
Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.
By Day 3 of Week 3
Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.
By Day 6 of Week 3
Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.
Great job on your discussion post. I agree with what you wrote about healthcare being an industry to bring in revenue. The objective to earn a profit from virtually every stakeholder that contributes to the United States healthcare system, often adds unintended costs to the system (Branning & Vater, 2016). A corporate model for healthcare organizations has overtaken the ‘treat-heal-care’ model, with the focus on cost efficiency as opposed to patient outcomes (Kelly & Porr, 2018). The values, mandate and vision of the nursing profession, have been perpetuated into a state of disconnect, through this healthcare reform (Kelly, & Porr, 2018).
It is essential for nurses to practice strong ethical principles in patient care, despite the latest healthcare reform’s corporate focus on revenue that is not patient-centered. Some guiding ethical principles are encompassing the intrinsic value of the caring act, holding patient’s personal values as important, taking patient’s concerns seriously and acting as their advocate, and setting and upholding a high standard of accountability (Groenewoud et al., 2019). It certainly sounds as though you were able to maintain strong ethical principles in patient care, throughout this troubling global pandemic. I commend you and your colleagues for your efforts.
Branning, G., & Vater, M. (2016). Healthcare spending: Plenty of blame to go around. American
Health & Drug Benefits, 9(8), 445-557.
Groenewoud, A. S., Westert, G. P., & Kremer, J. A. M. (2019). Value based competition in
health care’s ethical drawbacks and the need for a values-driven approach. BMC Health
Services Research, 19, 256. https://doi.org/10.1186/s12913-019-4081-6
Kelly, P., & Porr, C., (2018). Ethical nursing care versus cost containment: Considerations to
enhance RN practice. OJIN: The Online Journal of Issues in Nursing, 23, 1.
I enjoyed reading your article as I could relate and I’m sure most nurses could right now. At the facility I’m at, we had to do the same thing and reuse PPE. It seemed like everyday a new rule would come up and most things did not make sense. As nurses we are constantly reminded about the importance of evidenced based practice and how important using EBP in making safe patient care decisions. However, during COVID, It seemed like none of that mattered.
According to Rainbow et al (2020) prior to COVID, nurses were already leaving the field at exponential rates with more reports of mental health strain and physical health issues than in the past. The pandemic was the breaking point and I know many that have left the field or taken a break until things return to normal.
I myself have stepped back from accepting shifts from my PRN jobs due to burn out. This is sad as this is the time when nurses are critically needed. There has been too much changes to keep up with along with the physical fatigue of having to wear PPE for 12 hours.
The nursing shortage is alarming and dangerous. Katherine Ramos, an emergency room nurse in New York was interviewed and stated that people will die because realistically speaking, nurses cannot attend to 10, 20 or 30 patients (Fitzpatrick, 2020).
How was staff able to communicate their needs to leadership at your facility to initiate effective change?
Chen, S.C., Lai, Y.H., & Tsay, S.L. (2020). Nursing perspectives on the impacts of Covid-19. The Journals of Nursing Research, 28(3). Nursing Perspectives on the Impacts of COVID-19 : Journal of Nursing Research (lww.com)
Fitzpatrick, S., McFadden, C., Whitman, J., & Monahan, K. (March 24, 2020). U.S. hospitals brace for another challenge-an unprecedented shortage of nurses. U.S. hospitals brace for another challenge — an unprecedented shortage of nurses (nbcnews.com)
Mclernon, L.M. (Nov. 30th, 2020). COVID-related nursing shortages hit hospitals nationwide. CIDRAP News. COVID-related nursing shortages hit hospitals nationwide | CIDRAP (umn.edu)
Rainbow, J., Littzen, C., & Gelt, J. (Sept 15, 2020). Nurse burnout: The next COVID-19 crisis. The university of Arizona. Retrieved from Nurse Burnout: The Next COVID-19 Crisis? | University of Arizona College of Nursing
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