Contemporary Issues in Nursing - Report Example

Contemporary Issues in Nursing Nurses Floating Between Departments/Units Name of the Student Name of the University Introduction The world of medicine and clinical management has witnessed a fast evolving attentiveness to the relationship between staff issues at nursing and the repercussions for the treatment and care of patients. This has helped in getting the focus back on the processes and the importance of staffing decisions. However, with prolonged workforce shortages, staffing hospitals with an appropriate mix and number of nurses to provide safe patient care is now more difficult (Osterwell and Morley, 1997). Floating has emerged in recent times as one of the better known and more often adopted methods of dealing with staffing shortages. The process means that nurses are sometimes moved from the specialty in which they work to another area to alleviate the staffing difficulties. The following essay will analyze in some detail the problems of short staffing in the various medical management settings around the world that have led to the trend of floating. It was also attempt to analyze the advantages and disadvantages of floating and whether or not in the ultimate analysis floating is a process that could be adopted on a more long term basis for its merits over the accepted disadvantages. Nursing: Needs and Strengths Consistency in the staff providing care is important to ensure patient safety and continuity in care delivery (Jones, 2004). When staffing is stable, the work on the ward or unit is known and can be undertaken efficiently and with a minimum of explanation required. Nurses are more likely to be aware of the skills, expertise, strengths, and weaknesses of fellow staff members when they work with them regularly, while nurse managers are required to provide less supervision. Floating: The Concept: Floating and its related issues in nursing like many others involve the management of the workforce-the staff in an environment of a profession that is known world wide for its perpetual nature of being short staffed. There is in fact no real ‘simple’ acceptance to the understanding or the acceptance of the problems that are associated with the problems of floating.  Floating is one method that can help alleviate the burden and consequences of the nursing shortage (Urrabazo, 2006). Staff shortages or a nursing skill mix inadequate for client care are a worrying feature for most nurses given the fact that these situations cause the nurse to be concerned about the level of performance and delivery in the case of each client (Crisp, Potter, Taylor and Perry, 2005). The idea is that overworked staff is wrong for the health of any given business and its related professionals but overworked staff in nursing could even lead to mistakes that might be fatal. The fear is that the nurse would not be able to deliver optimal care. In Australia, itself, the problem of nursing shortage is acute which has meant that there is a concern that client maybe at risk from the staff shortages or the incorrect skill mix (Crisp, Taylor and Perry, 2005). It is in essence the responsibility of the management in the clinical setting to be aware of the needs of the warn in terms of nursing staff and ensure that the needs are met. Traditionally, there researches have held that there is a feeling of resistance within the nursing community with respect to the trend of floating (Cushing, 1983). There is an issue wherein none of the nurses really like the management function wherein the short-staffed requirements of the clinical management unit is satisfied with floating given the fact that floating as a process would take the nurse away from his/her zone of specialization and comfort never really allowing her to settle down to a particular specialization and in the process taking away from the optimal care that the nurse would have otherwise been able to provide the patients/clients. On the other hand, more recent research has demonstrated that fact that nurses have in fact chosen to float and have even believed that floating would widen the range and spectrum of their abilities and help them give more to their patients (Douglas et al., 2009). The data analyzed for 2008 included 182 facilities ranging in size from 25 to 979 licensed beds, with 22 states represented. The data indicate that RNs and non-RNs choose to float off their home unit around 25% and 40% of the time, respectively. Also, data representing the number of full-time employees (FTEs) engaging in self-directed floating and normalized for a hospital showed that each hospital saw an average of 11 RN FTEs and 12 non-RN FTEs per month chose to float outside their home units. Although the management might be required to do this to provide safe staffing levels, its is important for all nurses to recognize the limitations of their competencies and to advise the management and other staff on the unit to which they are moved of their inexperience and the limitations of their capabilities in dealing with and justifying the responsibilities being delegated to them. There is also the nurse’s knowledge in dealing with the application of the current knowledge about the specialty area (Roche, Pallas and Paul, 2009). If the management decides to move them despite the limitation that the nurse has expressed, it would be the duty of the nurse to ensure that she/he starts maintaining a personal file note of all the objections and concerns that they might be facing in the course of their work. There is also the issue that if the nurses are being moved around constantly within a particular place of employment, the management would have a responsibility to educate staff about the specialties to which they are likely to be moved. Some of the other major reasons why floating has become a trend is the fact that newer management techniques have meant that there are paid rotational training positions; short-term employment contracts for travelers, a policy to staff to a minimum level of occupancy which relies on "topping up" with agency personnel or floating staff from another unit, and increased casualization (non-permanent and part-time nurses) are a force of acceptance in many countries. The arguments that could stand to justify the factors of floating in clinical settings include factors such as floating would mean that there would be a greater conjunction with the newer models of management and professional development as it would mean that the nurse would slowly become adept at working in any given scenario with a high level of proficiency. Specializations are a good thing but excessive selections would mean that the growth of the nurse as a professional would be restricted (Cheery and Jacob, 2005). Floating does not allow this providing for the overall growth of the nursing staff. New technological solutions help leave behind the inefficiencies and limitations of a unit-based sign-up sheet. This common paper-based approach to having staff members choose their shifts generally hangs in the unit's break room or communication book. As the time of the open shift gets closer, the sheet is replaced by phone calls as the need to find staff willing to work becomes more urgent. As the beginning of the shift approaches, negotiations begin, and staff is moved around between units to balance talent with patient-care needs. With improved communications that allow all qualified staff to see available work, organizations move from limited unit-based awareness to organization-wide awareness of work opportunities. The disadvantages of the floating trend are there for all to see as well. The primary factor of disadvantage is the one that befalls the patient. The biggest ones with the problems are the patients who are not able to achieve any given sense of comfort for the patient. There is an increasing absence of the forces of continuity and in care (Cabana & Jee, 2004). Patients frequently comment that they have received care from a different nurse every day of their stay in hospital (Cabana & Jee, 2004).This has been called a nurse du jour, described as the phenomenon of different nurses attending patients throughout the course of their stay in hospital It is acknowledged that floating has its opposition, but the arguments posed are not justifiable when they are weighed against the consequences of not floating. There are significant costs associated with turnover resulting from losses in staff productivity for an organization (Jones, 2005). Beside these subtle disadvantages there are also the issues of professionalism and the loss of professional growth on part of the nurse in as much as they are unable to achieve a higher level of specialization. Conclusion Having made a case that puts forward the advantages and the demerits in some detail one can now analyze the ultimate solution to the problem. One has to remember that floating has developed in response to the issues of short staffing at the workplace. There is a crisis as far as the viability of nurses are concerned. The problem might exist in the echelons of professionalism and ethically it might be incorrect to over work a person but the solution is to reduce medical care or to leave sections unattended for longer periods of time. This is undoubtedly the worse of the two alternatives (Joint Commissions Report, 2004). Having said this, one can state with some confidence that until the problem of short staffing is dealt with in a comprehensive manner floating is one of the better accepted and acceptable alternatives. References: Crisp, J, Potter P A, Taylor C and Perry A G, 2005, Potter & Perry's fundamentals of nursing, pub, Elsevier Australia, p412 Douglas K, Rachael, K D, Pledger C and Schulman C A, 2009, Self-directed floating: Nurses are accepting its benefits, pub, (RN) Vol.72 No.5, pp32-35, accessed October 27, 2009, < http://rn.modernmedicine.com/rnweb/Modern+Medicine+Now/Self-directed-floating-Nurses-are-accepting-its-be/ArticleStandard/Article/detail/596884> Cabana M D and Jee S H, 2004, Does continuity of care improve patient outcomes? Pub, The Journal of Family Practice, Vol.53 No.12, pp974-980 Jones C B, 2004, The costs of nurse turnover: Part 1: An economic perspective, pub, Journal of Nursing Administration, Vol.34 No.12, pp562-570 Urrabazo K C, Said another way. Our obligation to float, pub, Nurse’s Forum, Vol.41 No.2, pp95-101 Joint Commissions Report, 2004, Improving Care in the ICU, pub, Joint Commissions Resources, pp103-105 Roche M, Pallas L B, and Paul C C P, 2009, The Implications of Staff ‘Churn’ for Nurse Managers, Staff, and Patients: The Consequences, pu, Nurse’s Economy, Vol.27 No. 2, pp103-110 Cheery B and Jacob S R, 2005, Contemporary nursing: issues, trends, & management, pub Elsevier Australia, pp167-169 Cushing M, 1983, The Legal Side: Fears of a Float Nurse, pub, The American Journal of Nurisng, Vol. 83, No. 2, pp297-298 Read More