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The Effects of Nurse Staffing on Quality of Care

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1- Lanecie

During my practicum, a clinical problem and social issue for health care is the impact of cigarette smoking on health. Smoking is the leading cause of preventable disease in the United States (Centers for Disease Control and Prevention, 2017). It is directly linked to stroke, coronary artery disease (CAD), lung cancer, and death (American Lung Association, 2018). It accounts for more than 480,000 deaths each year, or one in five (Centers for Disease Control and Prevention, 2017). Aside from the pain and suffering, smoking is a driver for escalating medical costs, most of which are avoidable (American Lung Association, 2018).

In 2016, 15.5% of the U. S. population were considered smokers. This statistic is down from 20.9% in 2005, but there has been no significant change since 2016 (Centers for Disease Control and Prevention, 2017). Some states like West Virginia, have smoking rates as high as 24.8% (Centers for Disease Control and Prevention, 2017). And smoking related illnesses generate medical costs of more than $170 billion every year and $156 billion in lost productivity (Centers for Disease Control and Prevention, 2017).

Current treatment modalities with over the counter nicotine replacement or prescribed psychotropics, such as varenicline, are not necessarily completed with clinical supervision or have long term success rates. There are multiple nursing problems that originate with a smoking addiction. For example, there are problems related to poor oxygen saturation levels for the patient with lung cancer and problems related to inadequate circulation for the patient with peripheral vascular disease. But the underlying nursing problem is treating the patient for the smoking addiction itself. This is the primary nursing problem.

A second nursing issue is the exorbitant avoidable medical costs that are burdening Medicare, Medicaid, and commercial insurance companies. It is a known fact that the tobacco industry advertises three times as much in low income neighborhoods (Sandel & Boynton-Jarrett, 2014). And in 2016, $5.8 billion was paid by the tobacco industry to cigarette retailers to reduce the cost of their cigarettes to promote sales (Centers for Disease Control and Prevention, 2017). Legislative influence by large nursing organizations will be required to impact the laws that protect the tobacco industry.

References

American Lung Association. (2018, January 1). Smoking facts. Retrieved from http://www.lung.org/stop-smoking/smoking-facts/

Centers for Disease Control and Prevention. (2017, February 1). Quitting smoking. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_s…

Sandel, M., & Boynton-Jarrett, R. (2014, March 31). Why do poor people smoke more?Retrieved from CNN: https://www.cnn.com/2014/03/26/opinion/sandel-pove…

2- Margot,

During my pracitcum, one of the problems I anticipate with this organization, like many other healthcare facilities, is short-staffing, especially on night shift, which is the shift I currently work. Recently, one of our “relief” L&D charge nurses took a permanent “day” shift position, which also leaves us short-handed for both a staff and NIC position. This affects quality and safety of patient care and nurse morale. (Summer is also traditionally a busy time in the maternity world, so this is also a factor.) It increases our stress levels and contributes to nurse fatigue and burnout. It also affects our legal liability as we are a perinatal unit, which is typically very litigious in nature. Another challenge is going to be that we will no longer have OB/GYN residents on night shift as of July 1st. We have come to depend on them for emergent care of our patients and a safety net of sorts. So, we will have to adjust our expectations accordingly. We do have a couple of “experienced” L&D nurses who will rotate shifts and anticipate them being off orientation relatively soon, so that should help our staffing situation somewhat.

3-Catherine,

I am not allowed per my company to do my Capstone in my own unit even though I wish I could. I am going to answer this question about my own unit though. I have not yet looked at the staffing issues on the unit I am going to do my capstoneon although based on the “Job Board” the are needing nurses also. It will tie into my capstone, but is not the focus.

Nursing shortage or I should say RN shortage in my hospital is an obvious concern. In my 7 1/2 years of working there, the use of Agency and Contract Pool nurses is something that we always seem to have now. Just this past month we have hired 5 FT Pool contract nurses. Our unit has experienced quite a turnover for nurses over the past 2 years. A recent expansion and renovation, a new nurse manager and various projects to increase “throughput” in the ER. With that said, overtime has increased, which means nursing staff is at risk for safety and burn out and compromises patient outcomes, safety and the delivery of care.

According to Martin (2015) inadequate nurse staffing affects both the patients and the employees. Workload intensifies, which leads to increase in job dissatisfaction, therefore causes employees to look for another company to work for. Martin (2015) further explained that one in five nurses plan to leave their job within a year due to insufficient staffing and adverse patient outcomes and increased nurse burnout. Working extra shifts or extended hours have substantial effects on medication errors, which leads to poor patient care delivery. According to Martin (2015), sufficient staffing saves lives. There have been multiple studies which show that adequate staffing is directly related to patient mortality rate. Therefore, sufficient staffing is a crucial element in order to deliver the best possible care and improve patient outcomes, patient and employee safety.

Reference

Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing, 24(2), 4-6.

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