Poor Patient Care due to Nursing Shortage Leading to Professional, Ethical and Legal Issues - Research Paper Example

?Management, Ethics and Law – Poor Patient Care due to Nursing shortage leading to Professional, Ethical and Legal issues Introduction In healthcare setting, nurses are the important players in nourishing and rehabilitating an unhealthy, injured, diseased individual back to a normal and healthy individual, thereby enabling him/her to live a happy and successful life. The roles and duties of a nurse have also evolved with the changing face of nursing. Rather than becoming few, they have become many, with nurses increasingly taking up certain duties that were previously left to the society. The development of nursing has also seen nurses evolve from general practitioners to highly specialized professionals, with areas of practice ranging from geriatric nursing to pediatric nursing. This has resulted in better patient care and higher patient survival rates. With rapid development of human society, and increasing health needs, this specialization across the nursing profession is bound to increase even more. However, there is another side to the above scenario. That is, due to number of factors, there is sizable nursing shortage throughout the world including in UK, and that is leading to poor patient care. The research suggests that shortage in nurses are happening due to the steep population growth, a diminishing pipeline of new students to nursing, a decline in nurses’ earnings relative to other career options, an aging nursing workforce, low job satisfaction and poor working conditions (Kaiser.edu 2005). Due to this shortage of nurses in healthcare settings, patients are put in a high risk condition, as they are not being given expected as well as adequate care leading to professional, ethical and legal issues Identification of the legal, professional and ethical issues A nurse will only “provide a structure of caring that can ultimately create an environment where… patient can begin transition from victim to survivor” (Johnston 2006). Thus, if the shortage of nurses accentuates, the ‘structure’ will collapse, leading to a lot of trouble and risks. Shortage of nurses is being witnessed in many UK hospitals in the past few years, thereby placing NHS in a peril state. Shortage is happening because many hospitals have placed a freeze on the recruitment of new nurses and also axing currently functioning nurses as well. “Many hospitals have been axing nursing posts or imposing recruitment freezes since 2005 and 2006, having racked up huge debts. Official figures show 5,964 nursing posts have been axed in the past two years. ” (Borland 2013). Shortage of nursing staff has major detrimental impact on quality of service of the hospital which directly impacts its reputation as well as on the hospital’s overall capacity to service (Buerhaus et al. 2007). More than the hospital’s image, valuable lives of people are at stake. People come to a healthcare setting in an already compromised state, with both their physical as well as mental health in a will be in a weakened state. That is, as people visit hospitals, when their physical body is malfunctioning, diseased and injured, their physical strength and also their mental morale will be at an all time low. Fig 1: (Borland 2013). Considering their state, it is of crucial importance for the healthcare professionals particularly nurses, as said above, to provide them with apt care and ‘nurse’ back to health. (Gosling and Mintzberg 2003). However, when there is shortage of nurses, all the patients may not be given apt and equal care, also may not be given quick care or care in times of need, and even deficient care. When this happens, many worst case scenarios arise. “Recent documents, including the infamous Francis Report, have exposed a catalogue of failings in the NHS, where patients have been neglected, poorly observed and physically abused. Findings detailed how patients were left unwashed; unable to eat and drink due to lack of help; and overall poorly managed in their final hours of need.” (The City Times). When these worse scenarios arise, the professional side of the nurses will be questioned. That is, when there is shortage of nurse, the physical and mental capabilities as well as the energy of the existing nurses will be pushed to the limits, and that could negatively impact their professional actions. (Harvey, Millett and Smith 1998). They may not be able to handle the organizational changes and the related changes in their function caused by the shortage of their colleagues, leading to stress and lack of focus, which will severely reflect in patient’s health. Nursing shortage and the resultant poor patient care also brings in ethical issues because patients get admitted to hospitals expecting optimum care. (May, Bazzoli and Gerland 2006). However, lack of nurses and care defeats their purpose of hospital stay and more importantly could even deteriorate their condition. This gives rise to an ethical question of how nurses could adopt nursing models which promote self-care among the patients. The legal aspect of nursing shortage can come into the picture mainly when there is loss of lives, and when the government tries to bring in legislations or the court of law takes the center stage to punish the individuals, who could be directly or indirectly involved in inadequate patient care, leading to loss of lives. Critical Evaluation of the professional issues When there are nurse shortages, the functioning nurses’ workload are pushed over the limits and that will negatively impact their professional workings, leading to poor patient care. Normally, the nurses would have been comfortable with the already running process including their responsibilities and tasks, and so would want to maintain or continue the status. (Curtis and O’Connell 2011). However, when more responsibilities arise due to lack of recruitment as well as axing of employees, apprehensions will arise in them because those changes would automatically bring about extra work. (Fulop et al. 2002). When such a scenario arises, they will first exhibit resistance to the new responsibilities. This issue of how employees will exhibit resistance was pointed by the Kotter and Schlesinger (1979, 451), who stated that change management is usually feared, because it means “disturbance of the status quo, a threat to peoples’ existing dubious interests in their jobs, and could also upset the established ways of doing things.” Baulcomb (2003, 277), further validates that perspective by stating how change and there resultant responsibilities is often resisted because they will have a fear of the unknown, causing anxiety, and so they will be naturally wary of any disruption from their normal routine. Then, when they are duty bound or even forced to take those responsibilities, it could result in heightened physical as well as mental stress levels in them. “There is an element of both stress and adaptation in health and in every disease. While some stress is needed for optimal health, productivity and morale, excessive stress increases the probability of ill health, low productivity and low morale” (Baillie and Trygstad, 1989). Fig 2: (RNdeer 2013) Thus, when the nurses experience higher stress levels, it will clearly reflect in the work, as their body and mind will not be able to exhibit its optimal best while taking care of the patients. Due to this stress, nurses’ physical and mental wellbeing will be affected particularly in the work environment, and that will logically result in deficient work and poor patient care. “Stress builds up and builds up and builds up until the giver of care just detaches, all of a sudden they are doing work, but they are not even cognizant of what they are doing, they are so stressed. They may forget to wash their hands.” (Sapatkin 2012). When this type of professional deficiency happens, it will accentuate the health risks of already diseased as well as recovering patients. These patients will already have a compromised health status including impaired immune system, and so lack of care on the part of the nurses could lead to more chances of infections, further deterioration of health and also death. (Johnson and Weber 2004) Researchers have found “that a 10 percent increase in a hospital's proportion of burned-out nurses raised urinary tract infections about the same amount, and surgical site infections more than 50 percent, from 4.2 per 1,000 patients to more than six.” (Sapatkin 2012). Thus, it is clear that when there is nursing shortage, it will severely impact the professional functioning of the existing nurses, causing impaired care on their part and thereby leading to poor patient care. Critical Evaluation of the ethical issues Nursing shortages and the resultant lack of personnel in the healthcare setting could also lead to ethical problems, considering the role of nurses being an all encompassing one. According to Watson (2003) any individual in a compromised health state needs to be cared for, respected, nurtured, understood, and assisted. The person should be given full care with respect and without any bias or shortfalls, so that person’s mind as well as the physical body not only recovers but also gets the much needed confidence. In addition, caring attitude has to be viewed and carried out as part of a nursing culture. That is, without focusing on the patient’s culture, race, etc., nurses need to incorporate caring attitude as part of their functioning, crossing all the cultural boundaries. According to Watson, caring attitude is not transmitted from generation to generation as a cultural thing; instead, “it's transmitted by the culture of the nursing profession as a unique way of coping with its environment.” (“Jean Watson”). Fig 3: (Karoub 2013) In addition, nursing has to be carried out by the nurses by fully understanding the illness of the patient, and treating not only medically but importantly humanely. “Nursing involves understanding health, illness and the human experience...” (Watson, 1999, p.80). When this is done, it will not only cure the physical health condition of the patient, but also it will elevate their mental health. However, all these ethical perspectives could be negatively impacted, if there is shortage of nurses. That is, as discussed above, nurses have a major responsibility to take care of the patients, along with other healthcare personnel. Their responsibility assumes more importance, as they are the ones who are in constantly touch with the patients during the entirety of the hospital stay. (Johnston 2006). Considering their importance, nursing shortages will have direct ethical impact on not only the patient care but also personally on the nurses. That is, as Erlen (2004), “persistent nursing shortage is challenging the values and beliefs of the nursing profession and causing nurses to ask how they can fulfill their ethical responsibilities to patients when there are an insufficient number and a maldistribution of nurses.” These ethical and thereby functional dilemmas on the part of the nurses could logically lead to deficient care to the patients. In addition, overwhelmed by this nursing shortage and lack of support, nurses will find to difficult to fulfill their duties and “could even go to the extent of warning the patients about conditions that are possibly detrimental to their welfare.” (Erlen 2001). Thus, as discussed above, nurses need to take an omnipresent role, but the nursing shortages gives them ethical dilemmas, and that leads to impaired functioning causing poor patient care. Critical Evaluation of the legal issues When the issues of nursing shortages and the resultant inadequate patient care are viewed from legal perspective, it gives rise to issue of how deficient or even life threatening care to the patients could cause legal problems for the nurses. When medical malpractice are reported in the media circles and taken to court of law, the focus of attention will be always on the concerned physicians.(Northouse 2012). However, the fact is nurses accompanying the physicians during the procedure could also be held for medical negligence, and so could be made as co-accused or even a defendant in the cases. (Clarkson 2009). Nurses could face such a grave situation, if they are, due to nursing shortage, forced to take more responsibilities and also carry out procedures in which they are not well versed. “Nurses can also commit most of the types of medical malpractice, such as giving the patient an incorrect dosage and not properly monitoring the patient’s condition.” (Medical Malpractice Help). That is, as mentioned earlier, when there is shortfall of nurses, the existing nurses could be forced to give a deficient patient care, and that could threaten and even kill the lives of those patients. “Evidence provided by the alliance shows that poor staffing levels can increase the likelihood of some care not being delivered by 66% and increase mortality rates in surgical patients by up to 20%.” (The City Times). When those eventualities occurs family of the patients could file complaints to relevant authorities and take the case to the court of law. When that happens, not only the professional career of the nurses but also their personal lives could be seriously affected. (Deans 2005). Hospitals along with the nurses could need to take the financial burden, if any compensation is ordered by the court. According to a 10-year study in US hospitals, “over $87.5 million was paid for malpractice claims involving nursing professionals.” (Medical Malpractice Help). Thus, it is quite noticeable that nursing shortages could force the existing nurses to provide imperfect care, leading to a defective patient care and thereby causing legal issues to them. Critical reflection Reflection Using Gibbs Model for reflection (1988). Fig 4: (University of the West of England) When this task was assigned to us, we initiated the process and it started off in a logical manner. Logical in the sense, the key aspects of teamwork as well as leadership and management was brought into the picture at the outset itself. That is, under the Gibbs Model for reflection, description initiates the process and under it, the key personnel of the team and the leader as well as the management personnel of the team are first described. On those lines, we all came together as a group, and then selected the team leader, co-team leader and also assigned other roles to the team members. After that, we decided to meet in-person outside of class and also communicated through emails, which strongly reflected our team work. That is, we decided to combine and discuss all the aspects related to the tasks, and that increased our team bonding. Even during the picking up of the article, like a optimal team, we listened to each others’ views, had a constructive discussion and picked up the best one. As far as feeling component of the model, we had mixed emotions during the task, but what aided the most in accomplishing the task is our strong team ethics as well as clear demarcation of leadership roles. That is, when we started the task, it seemed daunting at first, due to the vagueness of our task, doubts regarding how to start, etc. However, once we established our roles within the team, we felt confident and happy with the task ahead. Thus, during the task and also at the end of the task, we felt confident that we are working on the right lines and had reached a successful completion. Evaluation part of the Gibbs model was mostly on positive lines. As we all as individuals had a range of skills and knowledge to offer to the group, and as we are committed, cooperative, enthusiastic, punctual and also had mutual respect for each other, team work was optimal. In addition, the clear demarcation of leadership and management roles along with mutual respect for each other created a culture of openness, which also facilitated in the successful completion of the task. Although, there as a minor negative in the matter of taking more time to pick the title, the whole process was on positive lines. This positive effect could also be felt in the Analysis part, because the team dynamics were very good. To conclude, we all feel that we worked well as a team and that we all fulfilled our roles; and met our objectives well. The final stage of Gibbs model, the Action Plan also gave good perspectives because we understood how to manage time and importantly we would all gladly work with the same team members in future tasks as well, and will give our best to provide the best output. References Baillie, VK and Trygstad, LN., 1989. Effective Nursing Leadership: A Practical Guide. Jones & Bartlett Publishers Baulcomb, JS., 2003. Management of Change through Force Field analysis, Journal of Nursing Management, vol. 11, pp. 275–280 Borland, S., 2013. Shortage of Nurses is 'killing thousands a year'. [Online] http://www.dailymail.co.uk/health/article-2266158/Shortage-nurses-killing- thousands-patients-year-Patients-likely-develop-complications-properly- monitored.html(Accessed on October 24, 2013) Buerhaus, PI, Donelan, K, Ulrich, BT, Norman, L, DesRoches, C and Dittus, R., 2007. Impact of the Nurse shortage on Hospital Patient care: Comparative perspective. Health Affairs. vol. 26, no.3, pp. 853-862 Clarkson, M., 2009. “Leadership and Management in Nursing.” Waikato Institute of Technology. [Online] http://researcharchive.wintec.ac.nz/532/1/ Research_Project_2009_HLNU902_FINAL.pdf(Accessed on October 24, 2013) Curtis, E and O’Connell, R., 2011. Essential Leadership Skills for Motivating and Developing Staff. Nursing Management, vol.18, no. 5). Deans, C., 2005. Medication Errors and Professional Practice of Registered Nurses. Collegian, vol. 12, no. 1, pp. 29-33 Erlen, JA., 2004. Wanted-nurses. Ethical issues and the Nursing Shortage. Orthopaedic Nursing, vol. 23, no. 4, pp. 289-92. Erlen, JA., 2001. The Nursing Shortage, Patient care, and Ethics. Orthopaedic Nursing, vol. 20, no. 6, pp. 61-5. “Free Healthcare...At the Cost of your Life.” The City Times Fulop, N, Protopsaltis, G, Hutchings, A, King, A, Allen, A, Normand, C and Walters, R., 2002. Process and impact of Mergers of NHS trusts: Multicentre Case study and Management Cost Analysis, British Medical Journal, vol. 325, pp.246 Gosling, J and Mintzberg, H., 2003. The Five Minds of a Manager, Harvard Business Review Harvey, S, Millett, B and Smith, D., 1998. “Developing Successful Teams In Organisations.” Australian Journal of Management & Organisational Behaviour vol. 1, no. 1, pp. 1-8. Johnson, BM and Weber, PB., 2004. An Introduction to Theory and Reasoning in Nursing. Lippincott Williams & Wilkins “Jean Watson”. Nursing Theory. [Online] http://nursing-theory.org/nursing-theorists/Jean-Watson.php(Accessed on October 24, 2013) Johnston, BJ., 2006. Intimate Partner Violence Screening and Treatment: The Importance of Nursing Caring Behaviors. [Online] http://www.medscape.com/viewarticle/552755_3(Accessed on October 24, 2013) Kaiser.edu., 2005. Addressing the Nursing Shortage. [Online] http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=138(Accessed on October 24, 2013) Karoub, J., 2013. Patients refuse Treatment. [Online] http://www.usaonrace.com/focus-on-health/3952/patients-refuse-treatment-from- provider-because-of-race(Accessed on October 24, 2013) Kotter, JP and Schlesinger, LA., 1979. Choosing Strategies for Change, Harvard Business Review, vol. 57, no. 2, pp.451-459 “Medical Malpractice Help.” Filing a Lawsuit Against a Nurse. [Online] http://www.medicalmalpracticehelp.com/legal/filing-lawsuit-against-nurse(Accessed on October 24, 2013) May, HJ, Bazzoli, GJ and Gerland, M., 2006. Hospital’s Responses to Nurse staffing Shortages. Health Affairs, vol. 25, no. 4, pp. 316-323 Northouse, PG., 2012. Leadership: Theory and Practice. SAGE. RNdeer., 2013. We Can’t All Have Good Days. [Online] http://rndeer.com/blog/page/2/(Accessed on October 24, 2013) Sapatkin, D., 2012. Penn study examines link between Nurse Burnout, Care. [Online] http://articles.philly.com/2012-07-31/news/32943021_1_infection-data-infection- control-center-for-health-outcomes(Accessed on October 24, 2013) University of the West of England. Brief information on models of reflection. [Online] http://hsc.uwe.ac.uk/net/mentor/default.aspx?pageid=117(Accessed on October 24, 2013) Watson, J., 1999. Nursing: Human Science and Human Care : A Theory of Nursing. Jones and Bartlett. Watson, J., 2003. Jean Watson and the Theory of Human Caring. [Online] http://ww2.uchsc.edu/son/caring/content/wct.asp(Accessed on October 24, 2013) . Read More