Managing Changes during Clinical Staff Shortages - Essay Example

Mrs Woo, Department of nursing awareness, Mr knowhow, Area Healthcare manager, faraway NHS trust. 31st July 2006 REPORT: A STRATEGY PAPER FOR MANAGING CHANGES DURING CLINICAL STAFF SHORTAHES. Contents Page Executive Summary 1 Rationale for topic 2 Critical discussion 3 Conclusion 7 References 8 1. EXECUTIVE SUMMARY Clinical staff shortage is an increased crisis face nowadays. In most cases, such inadequacy in staffing has led to more problems for the administrators and managers of institutions. The goal of this paper is to determine the possible solutions that administrators can adopt in order to combat the problem. More specifically, this paper addressed the question of how clinical staff shortage may be managed. Also, this paper highlighted the various reasons as to why there is presently a shortage in clinical staff members particularly in UK medical and correctional institutions. Presented below are the findings and recommendations that have been determined in this paper: 1.1 Factors that are influencing the shortage include the increasing age of working nurses, the potential for retirement, reduced enrolment in nursing programs, poor compensation and increased demands 1.2 There is a misconception that the field of nursing is solely for women. With the increase in professional opportunities in other fields for women, there have been less people studying in nursing schools. 1.3 Administrators of medical institutions need to explore the various ways by which they can retain nurses and attract new ones to the profession in order to address the current and growing problem of shortage. 1.4 Various strategies that may influence the nurses today to stay in their positions and for people to be encouraged to study nursing. These include: Offering monetary incentives such as sign-on bonuses, tuition assistance, loan forgiveness, and salary increases; Offering flexible work schedules; Engaging staff in strategy development and decision making as a way of increasing job satisfaction; and Partnering with local colleges and universities to develop a stream of workers for the future. 1.5 Operational efficiency must be increased in order to lessen the need for staff member as well as lessen the effect of the shortage. 2 Rationale for choice of topic An analysis of the current state of the nursing profession makes it evident that there exists a current shortage in available nurses. Not only is this a problem for administrators of medical institutions, nurses across the country are experiencing the grip of this fast-moving shortage as well, including those who work in correctional facilities. The shortage of registered nurses is causing the quality of nursing services, provided by the hospitals, to drop down. More significant is the fact that such problem is not deemed as a short-term issue, in fact many healthcare managers now believe that it is a long-term problem that must be addressed at the earliest possible time. This is because the shortage is estimated to reach 500,000 positions by the year 2020 U.S. Dept. of Health and Human Services, 2002). A recent study by the Chicago tribune revealed that thousands of patients die every year because of the lack of sufficient staff. (Sechrist, Lewis 2000, pg 35) With such a situation, it is of great importance healthcare managers to find the possible ways by which they can deal with the current clinical staff shortage. Finding ways to manage such shortage is critical to all medical institutions including correctional facilities in order to properly provide quality service to users. This is the reason why managing clinical staff shortage has been chosen as the topic for this discussion. 3 Critical Discussion There are various factors that have been identified as contributors to the growing shortage in nurses. These include the increasing age of working nurses, the potential for retirement, and reduced enrolment in nursing programs, poor compensation and increased demands (AACN, 2006). It must likewise be mentioned that there has been a significant decline in the registered nurses work force in recent years. The number of students being enrolled in the nursing schools in the last few years has experienced a steep slump. Increase in professional opportunities for women in other fields is considered to be the primary reason. Moreover, the worsening working conditions in the profession of nursing is also a contributing factor. Another reason for why hospitals are facing staffing problems is that most of the professional nurses are hesitant to accept a job in positions where they will not be having reasonably trained staff to assist in their work. Mandatory overtime imposed by the administration of hospitals, overburden of patient care responsibilities and inability to report unsafe staffing practices are also the contributing factors. Studies have shown that the quality of nursing services declines with a decrease in nursing staff. Shortage of adequately trained nursing staff causes problems such as longer stays, higher death rates, and contraction with pneumonia during stay in hospital and several other infections. All of these factors have created an array of problems for healthcare managers and providers. As Breslin (2003) points out, "Shortages of clinical staff, including RNs, radiology technicians, Physiotherapy and many other professionals, not only severely limit the ability of healthcare providers to respond to increasing levels of demand, they also affect providers' ability to maintain current levels of service, quality, and profitability." One of the areas that is great affected by the shortage in nurses is correctional nursing and subsequently, correctional facilities. Correctional nursing is a relatively new concept. Although not having trained medical staff in a correctional facility is unfathomable to corrections, up until 15 to 20 years ago, correctional officer's dispensed medication and provided first aid, to name just a few duties. Administrators should be concerned about the nursing shortage. The actions of medical departments and their staff may directly impact the number of complaints, as well as medical lawsuits brought against the correctional facility. Correctional and medical administrators must work together to provide the resources necessary for the required "standard of care" (Keating 2001, pg 13). Productivity Enhancing Strategies Most of the time, healthcare managers have resorted to productivity-enhancing strategies in order to encourage current staff members to hold on to their positions and for prospective workers to consider the nursing profession. Such strategies include: 1, Offering monetary incentives such as sign-on bonuses, tuition assistance, loan forgiveness, and salary increases, 2, Offering flexible work schedules, 3, Engaging staff in strategy development and decision making as a way of increasing job satisfaction, 4, Partnering with local colleges and universities to develop a stream of workers for the future. (Breslin, 2003) Although such strategies have helped ease the shortage in staff, such attempts to fill the vacancies are successful to some extent but they only resolve the problem for short term. In order to tackle the problem in the long term some more issues to be addressed. Long-Term Solutions Primary issues that healthcare administrators should consider include improvement in the working conditions of nurses, provision of adequate and professional staff to support their work and be given enough liberty to control and direct their subordinates, and the implementation of a system that will ensure that non-nursing jobs are performed by the appropriate staff and not by the nurses. All the aforementioned suggestions focus on the supply-side of the issue. This means that all these techniques focus on increasing the supply of nurses. However, such strategies fail to provide healthcare managers with ideas as so how to continue to provide quality service despite the inadequate staff. According to Breslin (2003), this can be addressed by focusing on the demand-side strategies aimed at improving staff productivity. Basically, such strategies are implemented to ensure that the productivity of all staff members are maximised so that the service users do not feel the effects of the shortage. Layout Changes One operational strategy that health care managers may consider is to revise the physical and operational design of the facility in order to improve care and promote cost-efficient utilization of staff. These strategies will increase the operational efficiency of the facility thereby eliminating the quality and efficiency problems created by the shortage. Breslin (2003) points out another situation wherein operational efficiency may be increased. According to him: "Walking distances should be reduced when possible. Hospitals commonly have long, narrow "double loaded" corridors with patient rooms on both sides of the hall, and these inpatient units often are configured as either T-shaped or "racetrack" layouts with centralized staff stations and support areas such as medication rooms and supply closets. Nurses spend a good deal of time walking from patient rooms to the central station and back to update patient charts, provide bedside care, and retrieve supplies." The result of such physical design is that more nurses are needed to attend to the needs of the patients. In order to properly manage a facility with a depleted staff, healthcare managers should explore ways by which they can reduce the number of staff that they need. Centralisation of duties is a vital element to increasing operational facility and healthcare managers should look into all possible ways by which they can achieve such. Such strategy will not only increase efficiency it will inevitably make the lives of nurses easier. For one, changes in the layout will lessen the physical stress that nurses endure due to complicate and disorganised wards. However, the success of such strategy relies heavily on proper designation of duties. Before such strategy should be implemented, consultation with the staff should first take place. This should be undertaken in order to properly identify the problems of the staff with regards to the layout. The supervisor must likewise couple the layout changes with proper designation of duties and areas of responsibilities. This will enable the staff to concentrate on particular areas without having to move from one area to another. Also, designation of duties will lessen the likelihood of the staff being overworked since all the necessary responsibilities are properly attended to. The proposed changes should first undergo a preliminary test to determine its effectiveness in achieving its goal. Evaluation should come from the staff itself. They should be able to gauge whether the layout changes reduce their stress and make their jobs easier. Also, patient complaints and errors by staff members should be considered. A reduction in such factors will ultimately mean that the strategy is effective. 4 Conclusion The shortage of nurses as well as other clinical workers is an issue that needs to be addressed in the short term as well as in the long-term scenario. Healthcare managers should consider ways to improve operational efficiency in order to cope with the effects of a depleted staff. Increasing staff productivity is the only way by which healthcare providers can manage providing quality services to users even with an inadequate number of staff members. However, vast improvements must likewise be made to the nursing profession in order to ensure that medical and correctional facilities in the future will still have enough nurses to provide services to patients and other users. Addressing the shortage in nurses is vital not just to individual medical and correctional facilities, but to the whole medical services industry as well. 5 References American Association of Colleges of Nursing, (2006), Nursing Shortage Fact Sheet, Retrieved 21 July 2006 from: http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm. Breslin, Paul (2003), "Operational and design strategies for a reduced workforce: address staff shortages by investigating operational models and facility design that encourage efficiency and productivity," Healthcare Financial Management, 2003 March, Retrieved 21 July 2006, from: http://findarticles.com/p/articles/mi_m3257/is_3_57/ai_98953929. Keating, Sarah, (2001), The Nursing Shortage, Testimony to the California Assembly, October 30, 2001, Sacramento. Request by Assemblywoman Helen Thompson, pg 6-10. Sechrist, Karen, Lewis Ellen (2000), Adequacy of California's Nursing Work Force to the Advisory Committee to Implementation of Assembly Bill 655, Scott Bill, January 26, 2000, Sacramento. Sechrist, Karen (2000), Phase II: CSPCN/CIC Supply and Demand, at the National Council of State Boards of Nursing, (2000), Jackson Hole WY, pg 32-36. U.S. Dept. of Health and Human Services, (2002), Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020, Health Resources and Services Division, Bureau of Health Professions, National Center for Health Workforce Analysis. Walker, Polly, (2000), "Nursing Shortage: Truth or Fiction," Society of Professionals in Health Care, April 18, 2000, San Francisco, pg 12-14. Read More