What Does Nurses' Shortage Lead to - Term Paper Example

Case Study: Leadership Introduction There are various issues in nursing and in health care today. These issues often affect the quality of patient care and the way nurses eventually implement nursing interventions. Most of the time, these problems and issues can be addressed through proper and effective leadership techniques. These issues and problems in the nursing profession impact greatly on nursing care and on health care services received by the patient. The issue of nurse stress and burnout is currently becoming a major issue in nursing. With nursing shortage and the current economic crisis affecting health care services, nurse burnout and stress seems to be the overall outcome. Nurses are becoming overworked and underpaid and more often than not, this burnout will eventually lead to a bigger issue – an increase in medical errors and a decreased quality of health care services. This paper shall discuss the issue of nurse burnout and stress, including its causes and its effects. This paper shall also attempt to come up with appropriate solutions to this issue in the hope of effectively applying leadership skills and patient-centred solutions. Discussion Nurse burnout and stress Burnout or stress often manifests in various ways. But the most common manifestations include the following: insomnia, fatigue that does not go away with sleep, colds, headaches, backaches, nausea, allergies or difficult breathing, and skin problems (Sahota & Bruin, 2009). Symptoms of burnout may also include chronic exhaustion, frustration, anger, depression, irritability, cynicism, bitterness, and negative feelings towards colleagues and other people in general (Sahota & Bruin, 2009). These manifestations of burnout are also sometimes seen by patients as they are at the opposite end of such negative feelings. In an article by Fagin, et.al. (2006), authors discuss that many nursing graduates being initially fielded in the hospitals experience severe burnout in the first two years of their work most especially because of heavy workloads. A major paper conducted on the subject matter covered 225 junior hospital nurses working in different hospitals in Ontario and the study was able to establish that about 66% of these nurses were experiencing burnout, emotional exhaustion and even depression (Laschinger, as quoted by Fagin, et.al., 2006). In the study, nurses were also one in expressing that work overload, unfair workplaces, poor relationships with other staff, and weak leadership cause nurse burnout. This burnout among new graduates has a potentially heavier effect on nurses because these nurses are now more likely to feel ineffectual at work. Eventually also, they end up feeling cynical about their work and not being satisfied with their job. As these nurses have a hard time coping with work, their level of burnout also becomes higher (Fagin, et.al., 2006). Low job satisfaction often prompts these nurses to leave the profession in favour of more satisfactory and less stressful professions. As these new nurses leave the nursing profession, the nursing shortage is exacerbated and more work is assigned to fewer nurses. And so we see a vicious cycle in the nursing profession. A report from the Canadian Federation of Nurses Union (CFNU) set forth that poor working condition is one of the main causes of nurse burnout and stress. This poor working condition is also caused by tight hospital budgets (Fagin, et.al., 2006). The limited budget of hospitals often prompts administrators to cut or limit allocations for hospital needs and even hospital services. Consequently, the hospitals end up being poorly maintained, poorly equipped, and staff there poorly compensated. Moreover, older and more experienced nurses often do not have adequate time to train new nurses; and when they do have the time, the hospital cannot compensate them for the additional services for such services. As a result, new nurses often end up being poorly trained and thereby unable to cope with the challenges of the nursing profession. Laschinger (as quoted by Fagin, 2006) notes that “short-staffing means few hospitals can spare experienced nurses to mentor new ones, and as a result new nurses are confronting full hospital patient loads one week out of school”. In actual practice, because of limited nurses available to cope with patient numbers, patients are often discharged quickly or as soon as they are able to exhibit a semblance of independence in their daily functions. There is a dangerous risk associated with early patient discharge, one which may or may not manifest in some patients. These risks may range from infection to insufficient patient education and even to medical errors. The haste that seems to accompany patient care and discharge may further endanger the patient’s life because of the compromised quality of patient care. A case study on one of the nurses working in British Columbia revealed that she endured irregular shifts in her work as a nurse. She also often had to contend with having to be called in on short notice when the hospital she was working in was understaffed (Fagin, et.al., 2006). Consequently, with such a rigid and highly stressful work schedule, she felt mild depression and she experienced exhaustion at various points of her day and her work. She often felt that she was doing a bad job because she was always tired and seemed to be unwell most of the time when she was working (Fagin, et.al., 2006). The case study exemplifies the different challenges that nurses face while they are in practice. Administrators often try to get around the nursing shortage problem by discharging nurses before they shift so that they can call them earlier when the workload becomes overwhelming again for the hospital. However, this practice will eventually take its psychological toll on nurses who find it difficult to relax during their time out of the hospital because they expect to be called in anytime to work. All in all, this creates a highly stressful work environment for nurses and consequently it causes burnout. Many of the new nurses included in the study pointed out specific problems they often felt as a result of work burnout. Many of them felt that they find it terrifying to care for severely ill patients; they felt like they did not have the sufficient skills to adequately care for these patients (CBC News, 2006). This lack of confidence in their job has reflected to hospitals and ensuring the early discharge of patients leaving only those who were extremely sick. Many of these new nurses find the emotional challenge of their work difficult to cope with. And this emotional drain is compounded by 12-hour shifts with heavy workload in every minute of that shift. In actual practice, many of these nurses have opted to offer home and personal care for patients because it is less stressful for them (CBC News, 2006). And again, we see fewer nurses available to work in hospitals with many of them opting for home health care services. An article by McKiggan (2008) sets forth that overworked nurses are a major cause for medication errors. McKiggan (2008) claims that “nurses who worked in hospitals that were understaffed, had inadequate medical resources and who had high rates of overtime were most likely to report that patients had been the victims of medication mistakes”. He further points out that in Canada nurses who work overtime and who work in areas where staffing is already limited are also very likely to report medication or dosage errors in their practice. Statistics on this issue exemplify that in nurses who work overtime, about 22% report medication errors, as compared with 14% who did not work overtime (McKiggan, 2008). For RNs who worked in unfavourable working conditions, 27% of them reported medication errors in contrast to 12% in those who worked in favourable working conditions. Also, nurses who worked in environments where they got limited support, they were also more likely to report medication errors as compared to those who worked in a strongly supportive work environment (McKiggan, 2008). The article by McKiggan (2008) also pointed out that this low co-worker support may actually be due to limited hospitals staff; most of the time, nurses are busy and have less time to help or extend support to their co-workers. Less that 32% of nurses with low job security report medication errors as compared to 19% of those who have good job security (McKiggan, 2008). It is important to note that medication errors may have major and adverse consequences on patients. And most of these consequences are very much preventable. It is alarming to note that these preventable medical errors cause deaths in about 24,000 Canadians each year (McKiggan, 2008). In 2007, an assessment of Canadian nurses was conducted by Jamal & Bava (pp. 1072-5245) where they collected data from 175 nurses working in psychiatric hospitals in a large metropolitan eastern Canada. Their study sought to assess the relationship between shift-time and employees’ burnout, psychosomatic health, job satisfaction, skill use, intrinsic motivation and absenteeism (Jamal & Bava, 2007, p. 1072). The study was able to reveal that there was no relationship between shift-time and burnout among nurses. However, the study did reveal that the nurses who had rotating shifts and who were on night shifts were more likely to suffer more than nurses on other shifts. This study showed that the problem in stress and nurse burnout did not depend so much on the shift-time but more on the rotations and the manner by which the shifts were implemented on the nurses. Frequent rotations and night shifts are problem areas for nurses who found it more cumbersome and stressful to work under these conditions. In another study also covering psychiatric health nurses, researchers sought to assess the prevalence, distribution, correlates, and predictors of vicarious trauma and burnout among registered psychiatric nurses (Robinson, et.al., 2003). In this study, authors set forth that trauma and burnout are vital manifestations of workplace stress among nurses. And such stress can have disastrous consequences for professionals, health services and for consumers (Robinson, et.al., 2003). This study ended up surveying about 1,000 practising nurses in Manitoba, Canada. The study later revealed that RPNs experienced emotional exhaustion and high levels of personal accomplishment. The study stressed that exhaustion and stress experienced by RPNs affect their overall performance in the hospital; it also pointed out how important it is to reduce workplace stress in order to create a safer work environment for nurses, clients, and health services (Robinson, et.al., 2003). Solutions to Nursing Burnout There are various solutions which may be adapted in order to solve the nursing shortage issue. Firstly, the government must address the nursing shortage problem. Since shortage often causes burnout among nurses, the government can offer incentives to ageing nurses in order for them to postpone their retirement. Secondly, the government can help reduce nursing shortage by handling the cost of, not just training new nurses, but also of maintaining and updating the skills of nurses (Shergill & Rivera, 2007). Student grants to students can also help provide incentives to new enrolees to enrol in nursing. Also, more seats of employment can be opened in order to help motivate careers in nursing. The government can also offer incentives to entice more people to take it up as a career and for foreign graduates to immigrate and adjust to a new life in Canada (Shergill & Rivera, 2007). In order to specifically address the nursing burnout problem, nurses can lobby the government in order to exemplify how funding cuts cause problems in the quality of work and the quality of the health care system in general. These problems also potentially jeopardize the health of patients (Shergill & Rivera, 2007). Reports from the College of Registered Nurses of British Columbia (CRNBC) can offer the most appropriate information to the government, information which help support the fact that decreased funding by the government affects the health care system in general. Such reports can also point out how reduced funding has affected the health of health professionals, making them more vulnerable to illnesses (Shergill & Rivera, 2007). These reports submitted to the government can influence officials to increase the budget for the health care sector and thereby prevent burnout among the health care professionals. Another way of preventing nurse burnout is to engender respect for the profession by promoting a positive image of nurses. The media can help in this regard by helping educate the public and broadcasting positive and correct information about the profession; also by portraying nurses not in the typical image that they are always portrayed in movies or in television (Shergill & Rivera, 2007). The perception of the nursing profession is that it is only about picking up and cleaning up after patients; but it is also about independent care, and certainly more than just being a doctor’s assistant blindly following orders. In order to further strengthen the credibility of the nursing profession, the BCNU and the CRNBC can help draw in the appropriate and much needed attention towards the profession and to their patients. The BCNU can help exemplify the physical, emotional, psychological, spiritual effects of burnout on nurses (Shergill & Rivera, 2007). The CRNBC can also help in pointing out the effects of nursing burnout not only to patients, but to the general public as well. The nursing organizations in general can serve as the primary organizations which can unite the nurses and give them a more concerted action and direction in effectuating solutions to the nursing burnout and the nursing shortage problem. These organizations can be more effective in lobbying government officials for action. One nurse clamouring for action is hardly effective; however, when combined with the actions of other nurses, the clamour can prove to be more effective. Burnout is a problem which has affected and is continuing to affect many nurses in Canada; therefore, they should take on more concerted actions towards resolving this issue. Nurses can also do their part in order to prevent burnout. Burnout is not solely caused by the nursing shortage problem; it can also be caused or made worse by the nurses themselves. In order to prevent nursing burnout, the nurses have to keep open lines of communication with their managers and with their colleagues (Shergill & Rivera, 2007). By keeping the lines of communication open, they can express their feelings to their nurse supervisors, letting them know when they may not be comfortable with the work environment and the work policies being implemented in their workplace. Also, by keeping the lines open with their colleagues, nurses can engender emotional support for each other. Emotional support can make the work environment less stressful for nurses. It can also help ease the daily physical and emotional challenges that these nurses are bound to face on a daily basis. It is also important for nurses to stand up for their individual rights (Shergill & Rivera, 2007). Many hospitals apply unfair and unconscionable practices. They often take advantage of their nurses by making them work long and difficult hours. Nurses are also often placed on a floating status, not giving these nurses time to get used to a particular ward before transferring them or assigning them to other wards or hospital units. Floating has been practiced by hospital managers in order to manage the nursing shortage problem. However, this has created the problem of decreased and compromised quality of health care services delivered. Nurses should start saying no emphatically. This will force management to come up with decisions for the nursing shortage problem which would not rely too much on further burdening the nurses with longer work hours. Finally, it is also important for nurses to take care of their own health (Shergill & Rivera, 2007). Through healthy diet and exercise, nurses can cope and adjust well to change and to the physical and emotional challenges of their work. By taking proper care of their health, nurses can help prevent their own burnout and consequently allow for a healthier work environment. In connection with the inaccurate reports by the media on the nurse burnout issue, it is also important for nurses to become a more active voice in the press. Nurses must be more active in putting across the message that although nurses experience burnout, that patients are still safe in their care. Society will now be more enticed to view nurses in a favourable light – as hard working health professionals, and not as harried handmaidens who can barely care for their needs. “Central to this issue is the need to revise how nurses are valued” (Nevidjon & Erickson, 2001). When people place a greater value on nurses, then their monetary value can be increased as well. Another direct and practical solution to this nursing burnout and nursing shortage problem is for nurses themselves to put across the right impression about the profession. This especially applies to families, to mothers or fathers who often do not encourage their children to enter a career in nursing. Many nurses report that they do not want their children to choose nursing as a career (Nevidjon & Erickson, 2001). This should not be the case, because this creates the impression that nursing is not a desirable profession to be in. In order to prevent this unfavourable perception of the nursing profession, nurse executives can start organizational campaigns in order to educate nurses on how to communicate and talk about their profession in a professional and a social setting (Nevidjon & Erickson, 2001). And these nurse supervisors can combine their efforts with those of other nursing organizations in order to improve the image of nursing. This was applied by a school in America where they partnered their efforts with a public relations firm in order to improve the image of nurses and to eventually entice college entrants to enrol in nursing. Entrants into the nursing profession can also be increased by implementing new models of education which are needed in order to implement new models of patient care delivery (Nevidjon & Erickson, 2001). Traditionally, nursing practice and nursing education do not always align well with each other. This often adds to the need for more rigid training for new nurses; training that often does not coincide with what student nurses are taught in the classroom. Consequently, these new nurses often end up being a bane, rather than a boon to the nursing profession. Another crucial solution which can be implemented for the nursing profession in order to deal with the nursing burnout problem is to retain the current nursing population. The nursing burnout problem is causing many nurses to leave the profession. A major solution to this problem is in the hands of healthcare executives who must learn to value their employees (Nevidjon & Erickson, 2001). This process can be facilitated in partnership with the department of Human Resources who can facilitate the improved relationship between the nurse and the nurse managers. Nurse Managers can also ensure that nurses do not leave the profession by identifying “what benefits would keep nurses in the profession and in a particular work setting” (Nevidjon & Erickson, 2001). In establishing which benefits can keep the nurses within the profession, it is possible to get these current nurses within the nursing profession. Conclusion Nurse burnout and stress is a direct result of the nursing shortage problem. As there are fewer nurses to care for patients, the remaining nurses are pressured to cope with the burgeoning patient numbers. With this growing pressure, many nurses become physically and emotionally exhausted. They become stressed and burnt-out. Consequently, the quality of their nursing care is not its best and they become highly prone to medical errors. Solutions to this nursing issue come from the nurse managers and from the nurses themselves; for them to be participative in efforts to pressure and lobby government officials to come up with solutions to the nursing shortage problem. It is ultimately a responsibility personal to each nurse, one that calls on all nurses to do more than their fair share in resolving the issue. Works Cited Fagin, C., Maraldo, P., & Mason, D., 27 February 2006, "By far the worst burnout levels Ive ever seen", Nursing Advocacy, viewed 16 January 2010 from http://www.nursingadvocacy.org/news/2006/feb/27_canadian_press.html Jamal, M., Bava, V., July 1997, Shiftwork, burnout, and well-being: A study of canadian nurses, International Journal of Stress Management, volume 4, number 3, pp. 1573-3424 Jennings, B., (n.d) Chapter 26. Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions, Patient Safety and Quality: An Evidence-Based Handbook for Nurses, viewed 16 January 2010 from http://www.ahrq.gov/qual/nurseshdbk/docs/JenningsB_WEWCN.pdf McKiggan, J., 16 May 2008, Overworked Nurses Causing Medication Errors, Halifax Medical Practice, viewed 16 January 2010 from http://www.halifaxmedicalmalpracticelawyerblog.com/2008/05/overworked_nurses_causing_medi.html Nevidion, B. & Erickson, J., 31 January 2001, The Nursing Shortage: Solutions for the Short and Long Term, Online Journal of Issues in Nursing, volume 6, number 1, viewed 16 January 2010 from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workplace/NurseShortageStaffing/NursingShortage/Resources/NursingShortageSolutions.aspx New nurses facing stress, burnout, survey finds, 28 February 2006, Canadian Broadcasting Centre, viewed 16 January 2010 from http://www.cbc.ca/health/story/2006/02/28/nurses-burnout060228.html Robinson, J., Clements, K., & Land, C., April 2003, Workplace Stress Among Psychiatric Nurses: Prevalence, Distribution, Correlates, and Predictors, Journal of Psychosocial Nursing and Mental Health Services, volume 41, number 4 Sahota, K. & deBruin, N., 2009, Preventing Nurse Burnout, Nursing Informatics, viewed 16 January 2010 from http://www.nursing-informatics.com/N4111/fall2009/nathene_kim.ppt Shergill, G. & Rivera, N., 2001, Nurse Burnout – What We Can Do To Make A Change, Nursing Informatics, viewed 16 January 2010 from http://www.nursing-informatics.com/N4111/fall2007/NurseBurnout.ppt Ubelacker, S., 26 February 2006, High proportion of recent nursing grads experiencing burnout: study, Canadian Press Read More