BY DAY 3 OF WEEK 1

Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

BY DAY 6 OF WEEK 1

Respond to at least two of your colleagues on two different days who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.

• An issue/stressor that has impacted the healthcare field is the nursing shortage. The nursing shortage has been at an all time high this year. “Currently, the national average for turnover rates is 8.8% to 37.0%” (Haddad, et.al, 2022)  in 2022 of nurses leaving the nursing field. The COVID pandemic has had a great effect on increasing the turnover rates, because it has caused nurses to burnout. “ Nurses are considering leaving the profession in large numbers after bearing too much of the burden of the country’s response to the pandemic” (Zhavoronkova, et.al 2022). During the COVID pandemic nurses not only had to work in unsafe working conditions, but they had more patients than ever before.

  I work on a medical-surgical/telemetry unit where our patient ratio is 1:5. We are only allowed to have 3 telemetry patients at one time as well. During the COVID pandemic we had up to 7 patients with 5-6 telemetry patients which is very unsafe. They also extended our floor giving us 10 extra beds, which meant that less nurses were taking on more patients. Before the pandemic we had a total of 6 nurses, but after just a few short months 4 of these nurses had quit, leaving just myself and another nurse making things very hard. There were days that whole floors had to be shut down and people had to be transferred to different floors, because there was no staff to take care of the patients. Many nurses left due to these unsafe conditions “A study of 422,730 surgical patients in 9 European countries showed that patients were more likely to die 30 days after admission when the nurses workload was increased by 1 patient” (Bourgault, n.d). It’s hard to take care of patients with such a big workload.

  To deal with this issue the manager attempted to hire more staff, but people would come in for a few days and would quit, because of the intense workload. The manager had to then hire travel nurses to help us take care of the patients, but the travel nurses would also only be there for a limited amount of weeks, which would make us short again. The nursing shortage is still occurring on our floor with staff getting hired and quitting at the same time. If the workload wasn’t so heavy, maybe more nurses would be willing to stay, but even now the patient ratio hasn’t returned to normal yet it’s still 1:6.

   

  Bourgault, A. (n.d.). The Nursing Shortage and Work Expectations Are in Critical Condition: Is Anyone Listening? AACNjournals.org. https://aacnjournals.org/ccnonline/article/42/2/8/31717/The-Nursing-Shortage-and-Work-Expectations-Are-in

  Haddad, L., Annamaraju, P., & Butler, T. (2022, February 22). Nursing Shortage. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK493175/Links to an external site.

  Zhavoronkova, M., Custer, B., & Neal, A. (2022, June 7). How to ease the nursing shortage in America. Center for American Progress. https://www.americanprogress.org/article/how-to-ease-the-nursing-shortage-in-america/

   

  • i.

    You make great points about the nursing shortage. Our ratio is 1:7 still for telemetry. It used to be 1:4. The turnover in our hospital is also at an all time high. It is hard to find good nurses, why not work to retain them? “Research shows that a heavy nursing workload adversely affects patient safety” (Carayon & Gurses, 2008). When nurses are expected to do twice the amount of work in the same amount of time as previously, it causes the patient’s care to suffer. One study has found that “87% of nurses [interviewed] said they’ve felt burnt out in the past year” (Gaines, 2022).  The healthcare system needs reform, that’s for sure. Nurses need to feel supported. Patients need to feel cared for. Nurses need to have the time to  care for them.

    Respectfully,

    References

    Carayon P, Gurses AP. (2008). Nursing workload and patient safety—a human factors engineering perspective.  Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved December 1, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK2657/Links to an external site.

    Gaines, Kathleen. (2022). What’s really behind the nursing shortage? 1,500 nurses share their stories. Retrieved December 1, 2022 from https://nurse.org/articles/nursing-shortage-study/
•           There are many challenges that our leaders face in today’s dynamic health care industry. One must always be willing to change in order to maintain the complex environment. Healthcare industry costs are at an all-time high (Broome & Marshall, 2021). Decreasing costs while increasing efficiency, safety, and productivity are some of the main focuses of the Triple Aim (Broome & Marshall, 2021). One way to address this issue is by  shifting focus to maintenance of health in home-based settings, such as transitions of care, medication management, and improved care coordination (Broome & Marshall, 2021). With the emergence of the Affordable Care Act, prevention and maintenance of health is viewed as a critical component to decrease hospital costs and improve the health of population (Broome & Marshall, 2021). Improving health care delivery systems holds organizations responsible for the care provided to patients across the community as well as acute care settings (Ricketts & Fraher, 2013). Because reimbursements are based on outcome delivery, it is essential that healthcare organizations adopt to this change (Park et al, 2018).

  One way that organizations have adapted to this is through resource utilization and adding advanced practice nurse (APN) to improve access to care and decrease costs (Ricketts & Fraher, 2013). By adding more APNs into primary care workforce and care delivery models, preventative care can be attainable and help lower costs for both hospitals and patients (Ricketts & Fraher, 2013). Strong primary care services have been associated with improved outcomes, lower hospital costs, and decreased burden on acute care settings (Park et al, 2018).  In addition, this also helps to alleviate the strain on today’s primary health care physicians because it allows comanagement of patients (Norful et al, 2018). Shared responsibility helps increase value of care which increases reimbursement to providers (Park et al, 2018).

  The facility I work in has increased utilization of APNs in many areas. One such area is the cardiac access unit, which is a unit which hosts a lot of same day surgery and procedure patients who may or may not get admitted. The primary role of the APNs in this unit is patient teaching. Patients are given one on one time with an APN to review procedure, restrictions, medications, and follow up care management. Patients are also called at home to follow up with care in home setting. It is clear the adapting to the care delivery models, patients are given education that provides them with responsibility in their care. The triple aim mentions that supporting patients in their health management is essential to its goal. Reconfiguring the roles of APNs to meet the needs of the health care system will be seen moving forward to meet the goals of the Triple Aim and beyond (Gerardi et al, 2018).

  Theory of complex adaptive systems refers to an organization’s ability to adapt to change (Broome & Marshall, 2021) The ability to adapt pushes forth new ideas and solutions to problems which fosters growth and strength within this environment (Broome & Marshall, 2021). Flexibility and forward thinking will continue to be the forefront of today’s evolving health care field.

   

  References

  Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

  Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared workforce goal. American Journal of Nursing, 118(2), 43–45.

  Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain. Annals of Family Medicine, 16(3), 250–256.

  Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary care and its impact on the Quadruple Aim. Journal of the American Board of Family Medicine, 31(4), 588–604.

  Ricketts, T., & Fraher, E. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected. Health Affairs, 32(11), 1874–1880.

   
  • •  

• Increasing Healthcare Cost as a National Stressor that Impacts Healthcare

   

  Americans are burdened with the world’s costliest healthcare. In 2018, total healthcare spending in the United States rose to $3.6 trillion, or $11 172 per person. In 2017, the average spending was $10 739. With no guarantee of an increase in wages yearly, the increase in healthcare costs has added to the stress and anxiety of most individuals and the government. There is a growing fear that a single hospitalization or illness can wipe out one’s entire savings and still incur huge debts which will take decades to clear. As care prices spiral upward, millions are borrowing money, skipping treatments, and cutting back on household expenses to access needed healthcare (Lyford & Lash, 2019).

  One might think that, with the high expenses associated with health, the United States will be among the top countries with the healthiest population. Unfortunately, the nation ranks near the bottom of major health indices among developed nations, including life expectancy and infant mortality (Organisation for Economic Co-Operation and Development, 2021)

  Total national health expenditures in 2019 alone were $3.8 trillion. Of the total expenditure, health expenditures for hospital care was 31.4 percent, and that of physician and clinical services totaled 20.3 percent. In the year 2020, the total national health expenditure had increased to 4.1 trillion. even though 2020 can, in part, be attributed to the pandemic, the fact is that national health expenditure keeps rising (Centers for Disease Control and Prevention, 2022). And when healthcare costs rise, businesses and consumers suffer financially, and state and federal budgets also take a hit.

  As a nurse, I have seen more people tell the doctor to discharge them because they couldn’t afford a night in the hospital. A lot of middle-aged people don’t even have Primary Care Physicians and do not go for routine checkups. Most patients also have jobs but do not really have good health insurance, so they get stressed over medical bills. There is a trend of hospital admissions with no past medical history being reported for conditions like CHF, ARF, and other cardiac conditions.  The hospital I work in tries to help patients by sponsoring their transportation back home. Sometimes, they are able to get a month’s supply of prescriptions before patients get discharged. Social workers also help in getting patients into support groups that can help donate supplies for insulin. This may not sound like much, but the hospital is also suffering from patients with no health insurance who had been admitted and treated and remains admitted pending a discharge plan. Incidences of patients staying over 60 days due to placement issues are becoming rampant. My hospital is currently cutting back on some supplies in the use of patient care. For example, our straight catheter kit was replaced with ones that did not have the iodine swabs for cleansing the area, which in my opinion, is an infection risk. They have also decided to stop supplying cleaning wipes and only use towels which are supposed to be washed and returned to the units to manage all types of incontinence. These are all means to cut back on the daily cost of staying overnight. In the name of reducing cost, quality tends to be affected. How healthcare costs can be reduced without compromising on quality is indeed a herculean task that requires federal intervention if it can be helped. According to McCullough et al., the divergence in healthcare spending isn’t also producing any commensurate value as the US is lagging behind other OECD nations, and the gap in life expectancy is expected to widen if something is not done about it.

   

  References

  Centers for Disease Control and Prevention. (2022). FastStats – health expenditures. Retrieved November 30, 2022, from https://www.cdc.gov/nchs/fastats/health-expenditures.htmLinks to an external site.

  Lyford, S., & Lash, T. A. (2019). America’s Healthcare Cost Crisis: As the costs of U.S. healthcare continue to escalate, three commonsense reforms could reverse this unsustainable trend. Retrieved November 30, 2022, from https://library.lincoln.ac.uk/items/eds/a9h/141873009?resultsUri=items%3Fquery%3Dsubject%253A%2528Medical%2Bcare%2529%26facet%255B0%255D%3DSubjectEDS%253Ahealth%2Bcare%2Breform%26facet%255B1%255D%3DContentProvider%253AAcademic%2BSearch%2BComplete%26facet%255B2%255D%3DSubjectGeographic%253A%2522united%2Bstates%2522%26target%3Deds&facet%5B0%5D=SubjectEDS%3Ahealth%2Bcare%2Breform&facet%5B1%5D=ContentProvider%3AAcademic%2BSearch%2BComplete&facet%5B2%5D=SubjectGeographic%3A%22united%2Bstates%22Links to an external site.

  McCullough, J. M., Speer, M., Magnan, S., Fielding, J. E., Kindig, D., & Teutsch, S. M. (2020). Reduction in US health care spending required to meet the Institute of Medicine’s 2030 target. American Journal of Public Health, 110(12), 1735–1740. https://doi.org/10.2105/ajph.2020.305793Links to an external site.

  Organisation for Economic Co-Operation and Development (OECD). (2021). OECD Health Statistics 2021.  Retrieved November 30, 2022, from https://www.oecd.org/els/health-systems/health-data.htmLinks to an external site.

   

• NURS 6053

  Discussion Week 1

       The national nursing shortage is a continuous healthcare issue that has affected us tremendously today in our healthcare system. During the COVID-19 pandemic, the nursing shortage gap increased due to stressful, critical situations the pandemic brought into the hospitals. This caused nurses to burn out and experience a significant amount of stress due to a lack of support, equipment, and nurses (Bourgault, 2022). However, pre-pandemic, there was still a significant nurse shortage, as baby boomer nurses were retiring in 2010, roughly 60,000 yearly (Buerhaus, 2021). This meant that by 2020-2030, we would expect over 600,000 nurses to retire.

        A national nursing shortage impacts the system by affecting access to care, quality, safety, and costs (Bourgault, 2022). In the health organization I work for, we were heavily affected by the nursing shortage. Pre-pandemic, the organizations had over 200 vacant nurse positions open, and post-pandemic, that number increased to 500 registered nurse positions. This led to many issues, particularly nurse shortages in many units across the organization, which meant nurses were out of ratio with patient assignments. On average, in med-surge units, the nurse ratio was 1:4 for telemetry. During the nursing shortage, the nurse ratio was at many times 1:5 and 1:6. This caused frustration and a lack of support for the nurses.

          To help alleviate some of the burdens, our organization implemented a few things. With the help of some COVID relief money provided by the state. We were able to hire over 100 travelers to our organization to help lessen the burden. Also, the organization implemented bonuses for the extra shifts picked up by all healthcare providers. For example, if a nurse works their regular three 12 hours shifts, they may pick up extra shifts for that week, and each extra day, they would get overtime and an additional $500 dollar bonus.  This motivated many staff members to pick up extra days. The organization offering these types of incentives helped the nurses feel supported and able to provide safe, efficient care to their patients. However, these were all temporarily fixed for a much larger issue. We would go through phases of having enough nurses to being short staff. As mentioned in Leading in Healthcare Organizations of the Future (2015), Louis Rubino states it is essential for organizations to be aware of what is happening with the industry trend and find meaningfulness at work. This is a crucial factor for my organization to consider how to drive our vision and mission to our staff.

  References

  Bourgault, A. M. (2022). The Nursing Shortage and Work Expectations Are in Critical Condition: Is Anyone Listening? Critical Care Nurse, 42(2), 8–11. https://doi.org/10.4037/ccn2022909Links to an external site.

  Buerhaus, P. I. (2021). Current Nursing Shortages Could Have Long-Lasting Consequences: Time to Change Our Present Course. Nursing Economics, 39(5), 247-250. https://www.proquest.com/scholarly-journals/current-nursing-shortages-could-have-long-lasting/docview/2581886413/se-2Links to an external site.

  Walden University, LLC. (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: Author.
  • • Thank you Dr. Hart. That is a great question. I agree with Leslie, it is very black and white in many facilities. However from my experience of being bedside and stepping into a leadership role there was so many ‘ah ha’ moments which helped me understand why so many things were not implemented. I feel this goes just beyond nurses in hospitals.  It is easy to tell nurses to attend a mandatory meeting. I feel this is a topic needs to be taught in a during orientation of the nurses to the organization. This provides the nurse with the knowledge of how to be apart of the whole organization rather than learning as they go.

  •  

    I totally agree with you that nurses shortage is a great issue affecting most healthcare especially during covid pandemic.  Covid pandemic impact globally  affected healthcare delivery and financial results and, ultimately, the global supply chain. Inflation and the rising interest rates are directly correlated to the pandemic (WHO, 2021).  All healthcare providers have been challenged with adapting to a world that changed due to the Covid-19 pandemic.

    The response to Covid in the healthcare system was rapid. Due to the increased workload, staffing shortages, and constant changes, medical professionals are faced with high-stress levels and job dissatisfaction (WHO, 2021). Medical organizations must strive to focus on the Quadruple aim in healthcare. The purpose includes focusing on better patient outcomes, more accessible access to healthcare, decreased costs of delivery, and patient and provider satisfaction (Broome & Marshall, 2021). With the need for change accelerating, healthcare workers are under increased pressure to improve outcomes, and disengagement and professional burnout are at an all-time high. The focus needs to be placed on employee well-being and increasing employee engagement to assist organizations in meeting their goals. Achievement of the quadruple aim in healthcare should become the driver of improvement (Jacobs, 2018).

     

    References

    Broome, M. E., & Marshall, E. S. (2021). Transformational Leadership in Nursing (3rd ed.). New York, NY/: Springer Publishing Company.

    Jacobs, B. M.-B.-B.-K.-S.-B. (2018, July/September). Engaging Employees in Well-Being: Move from the Triple Aim to the Quadruple Aim. Nursing Administration Quarterly, 42(3), 231-245. doi:10.1097/NAQ

    WHO. (2021). Coronavirus. Retrieved from World Health Organization: https://www.who.int/healthtopics/coronavirus#tab=tab1

  •  

    The US Bureau of Labor reports that the nursing shortage is due to several factors, including change of occupation and retirement (Occupational Outlook, 2022). The average age of nurses is increasing; more than half of RNs are over 50, with 19% of RNs being 65 or older. Many nurses will retire within the next decade, leaving even more open nursing positions (Hamlin, 2022). This leads to another issue; according to Hamlin, in 2019 alone, over 80,407 qualified nursing applicants were turned away from nursing schools due to a lack of faculty and education space. A solution to the nursing shortage would be to build more nursing schools, hire more teachers, and not turn away so many qualified nursing students.

    References

    Hamlin, K. (2022, August 29). Why Is There a Nursing Shortage? NurseJournal. Retrieved December 1, 2022, from https://nursejournal.org/articles/why-is-there-a-nursing-shortage/Links to an external site.

    Occupational Outlook. (2022, April 8). U.S. Bureau of Labor Statistics. Retrieved November 28, 2022, from https://www.bls.gov/ooh/Links to an external site.
• Covid-19 Vaccine Hesitancy Among Nurses

  The issue that I selected for discussion is Covid vaccine hesitancy among nurses. The primary reasons that nurses refuse the vaccine are concerns about the safety of the vaccine, its effectiveness, unknown side effects, and religious reasons. Another factor stated by individuals against the vaccine mandate is that they don’t trust the government or drug companies. (Gustafson, 2021). Covid vaccine hesitancy in the nursing profession is an ongoing issue and has resulted in thousands of nurses being unable to practice their work. Although the number of nurses refusing the vaccine has decreased in the past two years, it is still high. For example, in 2020, the refusal rate among nurses was 23.4%, and in 2021 it was 18.3%. (Khubchandani et al., 2022). According to the American Nurses Association (ANA), eighty-eight percent of the nurses surveyed had received the vaccine. However, the same poll showed that only eighty-one percent said they were comfortable with the decision to get the vaccine. Moreover, only fifty-nine percent said that they supported the vaccine mandate. Eighty-four percent of those who refused the vaccine refused because they wanted more information. (Mclendon & Proctor, 2022).

  When Covid 19 first arrived, nurses showed up to work to care for affected community members in their time of need. Nurses risked their lives and those of their families to be at their job while the rest of the country was in lockdown. Due to the large influx of patients who tested positive for Covid-19, doctors, nurses, and other medical staff quickly became overwhelmed. Nurses served on the front line before the development of the vaccines and provided the best care available for sick and dying patients. At the same time, they were required to work tremendously long hours while being kept from their family and friends. These nurses were touted as heroes by the media as they served as the first line of defense in the fight against this illness. Then the vaccines were developed. Suddenly vaccines became mandatory for nurses, the people placing themselves at harm to care for those affected. Nurses were now forced to choose between taking a vaccine or losing their jobs and careers. As a result of the vaccine mandates, many nurses decided to leave their chosen profession. In interviews, doctors and nurses reported that they felt defeated by either the increased animosity from patients or the refusal of many in their communities to accept that masks and vaccines are safe. Nurses and other medical professionals went from hero to zero. During the height of the pandemic, the media praised nurses as heroes protecting society through the public health crisis. After the vaccine mandate, these same “heroes” were placed on unpaid leave or were fired for refusing to get the vaccine. One of the unintended consequences of the vaccine mandate is that vaccination became a condition of employment, leaving non-complying healthcare workers vilified because of a personal medical decision. Another consequence of the vaccine mandate is that it exacerbated staffing shortages. It only intensified an already stressed field that was experiencing shortages before the pandemic because the “heroes turned zeros” were forced to choose between their beliefs and livelihoods. (Cathell, n.d.).

  This national healthcare issue has had a negative impact on my previous work setting and it is one of the main reasons that I left. My previous employer was the University of New Mexico Hospital. As a condition of employment, I had to show that I had received the first shot and the booster. I presented my proof of vaccination to occupational health as part of the hiring process and I started my employment. Approximately six weeks later I was threatened with being taken off the schedule unless I brought my vaccination card to my director (this information had already been presented during my hiring process). Many other nurses quit or were placed on leave without pay because they had concerns about getting the vaccine. As a result, the unit that I worked on lost almost one-third of the nurses. This also affected the hospital finances in that they were forced to bring in travel nurses at much higher rates of pay. The result of this policy resulted in the loss of many years of experience when the nurses quit or were let go. This policy is unsustainable and will continue to be harmful to the nursing profession.    

  There are many different points of view on this issue. It is the right of every individual to refuse the vaccine. Individuals should be free to decide on taking the vaccine or not. Neither the government nor the hospitals view the vaccine as optional. Until a consensus is reached, the vaccine mandate’s negative effect on the nursing profession will remain. Nurses who do not wish to get the vaccine will continue to suffer from feeling that they have no support from employers or the public at large. A recent survey reports that among hospital RNs, forty-three percent said they had more trouble sleeping than before the pandemic, sixty-one percent reported feeling more stressed, and fifty-seven percent reported feeling more anxious. Fifty-one percent reported feeling sad or depressed. (Rollins, J. A., 2021). Add to that the requirement of getting the vaccine or losing your livelihood, and it is easy to see how healthcare will be negatively impacted. Shortages of qualified nurses and other healthcare professionals will continue, and many qualified healthcare professionals will leave the field.  

  References

  Gustafson, A. (2021, May 21). Why are some healthcare workers refusing COVID vaccines? Modern Healthcare. https://www.modernhealthcare.com/labor/why-are-some-healthcare-workers-refusing-covid-vaccines Links to an external site..

  Khubchandani, J., Bustos, E., Chowdhury, S., Biswas, N., & Keller, T. (2022). COVID-19 Vaccine Refusal among Nurses Worldwide: Review of Trends and Predictors. Vaccine, 10(2), 230. https://doi.org/10.3390/vaccines10020230 Links to an external site..

  McLendon, S. & Proctor, K., ANA Supports Mandated COVID-19 Vaccinations for Nurses and all Health Care Professionals (July 7, 2021), www.nursingworld.org.

  Cathell, M. (n.d.). “Hero to Zero”: Daily Caller documentary tells stories of first responders and teachers persecuted for refusing the COVID-19 vaccine. The Post Millenial. Retrieved November 30, 2022, from https://thepostmillenial.com/hero-to-zero-daily-caller-documentary Links to an external site..

  Rollins, J.A. (2021). Some Relief for Nurses Is on the Way. Pediatric Nursing, 47(2), 57-58.
  • Response

    Leslie, great post this week! Covid-19 vaccinations can be a controversial topic, even among the healthcare community. Just as you did, I am sure we all know nurses who left their positions due to not wanting to be vaccinated outside of medical and religious reasons. As you stated in your post, many felt that it was wrong of the government to force nurses out of their jobs for choosing not to vaccinate when it was those same nurses putting their life on the line before the vaccine was available. Many healthcare workers did, in fact, lose their lives to Covid-19, with approximately a third of those lost being nurses (Khubchandani et al., 2022). While the development and administration of the vaccine could help prevent future deaths, I am in agreement that all health care workers should make that decision with their physician, not because of a mandate.
    I also agree with you that this vaccine issue has made the staffing shortages even worse than they already are. I can say from personal experience that nursing homes, in particular, have been hit hard by staffing problems. Yet hospitals, too, have experienced shortages, with approximately twenty-four percent of hospitals reporting severe staffing shortages during the pandemic (Bourgault, 2022). It is difficult to say how much the vaccine mandate may have contributed to this, but either way, the impact on both the nurses who were forced to leave their jobs, and the ones who stayed and are burned out, cannot be overstated. Great job!

    Morgan Smith

    References

    Bourgault, A. M. (2022). The Nursing Shortage and Work Expectations Are in Critical
    Condition: Is Anyone Listening? Critical Care Nurse, 42(2), 8–11.
    https://doi.org/10.4037/ccn2022909Links to an external site.

    Khubchandani, J., Bustos, E., Chowdhury, S., Biswas, N., & Keller, T. (2022). COVID-19
    Vaccine Refusal among Nurses Worldwide: Review of Trends and Predictors. Vaccines,
    10(2), 230. https://doi.org/10.3390/vaccines10020230Links to an external site.

  •  

    In addition, I have also learned that there are several reasons for increased hesitancy among healthcare workers despite them being at risk for contracting COVID-19 disease. The rejection of the vaccine lowers the probability of achieving herd immunity hence extending the duration of the pandemic. Some of the reasons raised by the healthcare workers concerning the vaccine include efficacy and safety concerns since the vaccine was hurriedly developed and did not create adequate time for clinical trials (Leigh et al., 2022). The common concerns for the uptake of the vaccine include knowledge of the vaccines and their willingness to them. In addition, there were concerns about the development of mRNA vaccine technology that had been used in animals. There is a higher preference for physiological immunity compared to artificial immunity which is obtained through natural means (Peterson et al., 2022). There was a greater distrust in the government and the healthcare, organizations hence making it difficult for health professionals to believe them.

    References

    Leigh, J. P., Moss, S. J., White, T. M., Picchio, C. A., Rabin, K. H., Ratzan, S. C., Wyka, K., El-Mohandes, A., & Lazarus, J. V. (2022). Factors affecting COVID-19 vaccine hesitancy among healthcare providers in 23 countries. Vaccine, 40(31), 4081–4089. https://doi.org/10.1016/j.vaccine.2022.04.097

    Peterson, C. J., Lee, B., & Nugent, K. (2022). COVID-19 Vaccination Hesitancy among Healthcare Workers-A Review. Vaccines, 10(6), 948. https://doi.org/10.3390/vaccines10060948
•      One of today’s biggest healthcare issues is nurse burnout and staffing shortage.  As a standard of care, the expectation is always to provide adequate, efficient care to the patient population.  Nursing Administration Quarterly states, “Employees who are thriving in well-being tend to be more highly engaged.” (Jacobs, B. et al., 2018).  If there isn’t sufficient staff to provide excellent care, the same overused staff are substituted to get the job done. The staffing shortage in nursing is a huge deal. At my current job, we often must work additional hours to get the job done due to insufficient staff and callouts.   I am in management, and if there isn’t anyone to work the floor, I often am substituted to get the job done.  According to JONA,  “Nurses face workplace stressors that contribute to job dissatisfaction, burnout, and turnover, impacting not only patient safety but the nurses’ physical and emotional well-being. “ (Grant et al, 2020). Quality of work and patient care is decreased due to staff being tired from long hours, causing nurse burnout.  Nursing Administration Quarterly states, “CREATING healthy professional practice/work environments (PPWEs) for nursing practice is critical to maintaining an adequate nursing workforce.” (Bowles, J., Et al, 2019). For nurses to assist others, nurses must be well.

  My current job has a couple of things implemented to reduce nursing burnout and increase staff retention. If one is mandated to stay over for an extra shift, one may choose to have the next day off as a comp/mental health day if necessary. My current job also offers sign-on bonus for agreeing to work with the company for a year in exchange for the bonus and tuition reimbursement. I can attest that the comp/mental health day really helps you to reset and come back to work refreshed and ready to provide quality, top-tier care.  Currently, my job has hired quite a few nurses to complete and fill the floor needs. The staffing issue has not been completely remedied because staff retention continues to be an ongoing issue. In between the staffing shortage, we utilize agency staff to decrease burnout. I believe that our company has been listening to the staff’s concerns and are actively attempting to fix the issues at hand to retain the current staff. In my book, what more can one ask for from an employer?

   

  References

   

  Bowles, J. , Batcheller, J. , Adams, J. , Zimmermann, D. & Pappas, S.  (2019). Nursing’s Leadership Role in Advancing Professional Practice/Work Environments as Part of the Quadruple Aim.  Nursing Administration Quarterly,  43 (2),  157-163.  doi: 10.1097/NAQ.0000000000000342.

  Grant, S. , Davidson, J. , Manges, K. , Dermenchyan, A. , Wilson, E. & Dowdell, E.  (2020).  Creating Healthful Work Environments to Deliver on the Quadruple Aim.  JONA: The Journal of Nursing Administration,  50 (6), 314-321.  doi: 10.1097/NNA.0000000000000891.

  Jacobs, B. , McGovern, J. , Heinmiller, J. & Drenkard, K.  (2018).  Engaging Employees in Well-Being. Nursing Administration Quarterly,  42 (3),  231-245.  doi: 10.1097/NAQ.0000000000000303.

  • Week 1 Discussion Post

    The national nursing shortage is the national healthcare issue I have selected to discuss. According to the US Bureau of Labor Statistics, it is projected that there will be 203,200 openings for registered nurses each year, on average, over the next decade. The US Bureau of Labor reports that the nursing shortage is due to several factors, including retirement and change of occupation. (Occupational Outlook, 2022). By 2023, it is projected that 1.2 million new registered nurses (RNs) will be needed to address the current shortage (The 2021 American Nursing Shortage: A Data Study, 2021). 

    I work as a dialysis nurse in an outpatient clinic; the national nursing shortage has negatively impacted my work setting in several ways. For example, the lack of nurses has led to longer shifts and more workdays, leading to many nurses, including myself, being burnt out. Burnout can lead to nurses resigning or changing occupations entirely. Secondly, the lack of nurses has led to an increased patient load, affecting the quality of care and increasing errors. Thirdly, the nursing shortage has negatively impacted healthcare organizations’ financial positions. Hospitals are having to increase pay, enhance benefits, offer bonuses, and pay overtime to ensure staffing (Effects of the Continuing U.S. Nursing Shortage, 2020).

     My work has responded to the nursing shortage by offering higher pay and bonuses, hosting hiring fairs, hiring more float nurses, providing quality training to new dialysis nurses, and decreasing nurse-to-patient ratios. Two months ago, exact nurse-to-patient ratios had yet to be established at the dialysis clinic I work at. There was one nurse per 24 patients, which led to reduced quality of care, safety issues, and burnout. Now, there is one nurse per twelve patients. Our clinic recently conducted an employee satisfaction survey; data showed that employee satisfaction had increased from 67% to 78% since the nurse-to-patient ratio change. In conclusion, addressing and implementing solutions to help curve the nursing shortage is imperative to prevent nurse burnout and improve patient safety and quality of care.

     

    References

    Effects of the Continuing U.S. Nursing Shortage. (2020, December 18). Norwich University. Retrieved November 29, 2022, from http://accolades.norwich.edu/academic-programs/resources/effects-of-nursing-shortageLinks to an external site.

    Occupational Outlook. (2022, April 8). U.S. Bureau of Labor Statistics. Retrieved November 28, 2022, from https://www.bls.gov/ooh/Links to an external site.

    The 2021 American Nursing Shortage: A Data Study. (2021, May). The University of St. Augustine for Health Science. Retrieved November 28, 2022, from https://www.usa.edu/blog/nursing-shortage/Links to an external site.

     

    •  

      Your discussion post on the nursing shortage was well written, and provided a valuable yet painful reminder of one of the most critical issues facing the nursing profession. The problem is nothing new. However, since the outbreak of the Covid-19 pandemic, it has only gotten worse. Some health leaders have warned for years that hospitals will continue to face a nursing shortage. In my own experience, I have been forced to work mandatory overtime shifts, and at one point, I worked 22 days in a row during the end of the pandemic. This is one reason I left the hospital where I was employed. Nurses face a catch-22 situation in which they are forced to work more hours because hospitals are short-staffed. These extended hours and days without a break result in the departure of nurses from their places of employment. This, in turn, causes increased staff shortages, and the cycle is perpetuated. Unfortunately, the patients pay the ultimate price for the nursing shortage. The nursing shortage has directly impacted patient care as the nurse-to-patient ratio worsens. The shortage results from a combination of factors, including the retirement of baby boomers from the industry, the need for qualified nurse faculty, and nursing school enrollment capacity. (The Impact of Nursing Shortage on Patient Care, 2019).

      For years there have been warnings that hospitals will continue to face nursing shortages. The American Nurses Association lists the retirement of baby boomer nurses, an aging population that will require more medical care, faculty shortages that limit nursing school’s capacities to accept more nursing students, and more nurses moving away from direct patient care or leaving the health care field altogether because of stress. Finally, COVID-19 has intensified some of those conditions. (Boyle, 2021). As the next generation of nursing leaders, it will be our job to solve this problem. The nursing shortage is expected to increase by the year 2030. The US Bureau of Labor Statistics foresees 194,500 registered nurse (RN) job openings annually until 2029. (Boyle, 2021).

      A recent article lists six strategies that we as nurse leaders can do to increase nurse retention: Listening to nurses’ concerns, prioritizing workplace culture, adjusting protocol to meet nurses’ needs, increasing diversity and representation in nursing, addressing the need for more nurse educators, and, supporting nurses leading healthcare innovation. (6 Proven Strategies from Nurse Execs to Combat the Nursing Shortage in 2022, 2022). Whatever specialty we move into as advanced practice registered nurses, we can incorporate these strategies to help alleviate the problem of nursing shortages. As your article points out, higher pay, bonuses, hiring fairs, and float nurses help alleviate the issue, but we must all do more to increase nurse retention.

       

      References

      The Impact of Nursing Shortage on Patient Care. (2019, August 14). PRN Funding. https://www.prnfunding.com/impact-of-nursing-shortage-on-patient-care#:text=The%20nursing%20shortage%20has%20had%20a%20direct%20impact Links to an external site..

       

      Boyle, P. (2021, September 7). Hospitals innovate amid dire nursing shortages. AAMC. https:///www.aamc.org/news-insights/hospitals-innovate-amid-dire-nursing-shortages Links to an external site..

      6 Proven Strategies From Nurse Execs to Combat the Nursing Shortage in 2022. (2022, January 11). NurseJournal. https://nursejournal.org/articles/proven/strategies-to-survive-the-nursing-shortage-2022/#text.=6%20Innovative%20Ways%20Top%20Nursing%20Executives%20Are%20Surviving Links to an external site..
• The United States is currently facing a shortage of healthcare providers due to burnout, retirement, and the high cost of higher education. There is a severe shortage of Mental Health care practitioners in the United States, especially in rural areas (NAMI, 2022).

  NAMI (2022) reports that the United States needs 7500 additional mental health care providers. Residency positions in psychiatry have increased by 20 percent to decrease the shortage, and Nurse Practitioner (NP) and Physician Assistant programs specializing in psychiatry and mental healthcare have increased (Morreale et al., 2020). The Biden administration has provided 700 million to government agencies to support the education training and recruitment of mental health care providers in shortage areas (Kuehn, 2022).

  The lack of mental health care treatment for people in rural areas has caused more patients with mental health issues to be admitted into the medical units in rural hospitals. Patients with suicidal ideations, drug addiction, and other mental health crises are being treated on medical units and discharged without a mental healthcare provider for follow-up. The most extensive hospital system in my area has addressed this issue by hiring more Mental Health Nurse Practitioners in their outpatient clinics to address patients before they reach the crisis level. They also have scholarships to help nurses to become psychiatric NPs and loan repayment incentives to attract mental health care providers.

  References

  Kuehn, B. M. (2022). Clinician shortage exacerbates pandemic-fueled “Mental health crisis.” JAMA, 327(22), 2179. https://doi.org/10.1001/jama.2022.8661Links to an external site.

  Morreale, M. K., Balon, R., Coverdale, J., Louie, A. K., Beresin, E., Guerrero, A. P., Aggarwal, R., & Brenner, A. M. (2020). Supporting the education of nurse practitioners and physician assistants in meeting shortages in mental health care. Academic Psychiatry, 44(4), 377–379. https://doi.org/10.1007/s40596-020-01256-3Links to an external site.

  NAMI. (2022). The doctor is out. National Alliance on Mental Illness. https://www.nami.org/support-education/publications-reports/public-policy-reports/the-doctor-is-out