Nursing Workload and Patient Safety - Essay Example

Name Date Interview guide Nursing Workload and Patient Safety It is evident that heavy workload within hospitals is the main problem for Australia’s health care. According to Davis (2003), there are a number of reasons why nurses are experience higher workloads within their work. These reasons include; reduced staffing and increased overtime, inadequate supply of nurses, increased demand for nurses and reduction length on patient say. In Australia, the demand for nurses is constantly increasing due to increased aging population. Davis (2003) asserts that, the current supply of nurses within Australia is not sufficient to meet the growing demand for better health care. This shortage is expected to increase in future since nursing schools is not be able to keep up with the ever increasing educational demand. Darvas (2002) maintains that, there are numerous consequences that are associated to high nursing work load. The main impact on high workload is that it adversely affects patient safety. Factors such as historical, political, social and economic are known impact on patient safety. Expectation, patient acuity and work system widely contribute to the current work load within Australia. This essay focuses on understanding nurses’ workload and patient safety. Further, it will discuss on the social, political, economic and historical factors have widely contributed to workload and patient security. In addition, impact of nurses’ workload and patient safety on contemporary nursing practice from personal, societal, organizational and world perspectives. Finally, opinions and recommendation will be provided from the literature that surrounds’ the issue of nurses workload and patient safety. Carayon (2006) maintains that, there are various factors within hospital and health care institutions that are known to create an impact which results to nurses’ workload and patient safety. These factors can be categorized as political, economic, social and historical. Economically, it is observable that across the globe there is a major shortage of nurses. Most countries are limited financially thus train a small number of nurses that are not able to meet the growing health care demands. Those that are trained end up providing services for the few rich persons whose health care needs are less compared to their less fortunate counterparts but end up consuming the large health care proportion. This implies that the health care budget and services mostly benefits the rich than the less fortunate i.e. inverse care. In addition, limited finances affects the nurses as they are not able to gain the adequate medical specialization and emphasis is mainly based on the specialization in focusing on programs that are meant for disease controls. Thus the health care program is mainly fragmented especially for the marginalized groups and adversely under-resourced. The provision of services mainly for the diseases that are not a priority for the country is mainly unsafe. Due to human factors that are specific to nurses’ performance, nurses’ work under poor working conditions that are known to be as a result of economic hardship (Carayon 2006). The nursing workload can impact heavily on the impact of heavily on the patient safety. To begin with, the nurses who have heavy workloads lack sufficient time to enable them perform tasks in a safe way. The prehistoric factors have had considerable effect on the workload of nurses in the present. The early settlers and colonizers dictated on the persons that were to be trained as nurses. Until recently, the nursing profession was reserved for the female. Most of the nurses’ work was to perform the dirty work that the main doctor saw was not to his status to perform. The prehistoric factors also dictated the curriculum and the areas of specialization that the nurses had to take. Other prehistoric conditions included religion and culture. This specified and dictated the roles the nurses have to perform in respect to the prevailing cultural and religious conditions (Bathen S., 2004). Limitation in time will also result in the lack of the nurse communicating with the patients and other relevant medical providers that might be meaningful in the healing and medical process. In addition, heavy workloads to nurses results in the lack of motivation for the nurses. The lack of motivation shapes up in the nurses as they are never satisfied with their jobs. The nurses who are dissatisfied with their employment often end up performing below average as they have no positive intrinsic motivation to perform his or her duties. The lacking in motivation among the nurses results in frustration thus contributing to the development of high levels of negative attitudes towards the occupation (Carayon P, 2007). The nurse stress and burnout is as a result of heavy workloads which results in to them acquiring an increased negative attitude towards their occupation and the patients they are to attend to. The stress and burnout may also be as a result of the reduced cognitive and physical resources that are able to give the nurses the required information and debriefing that is essential for their work. The high work load in the cognitive level can result in errors which include slips, mistakes and lapses. To an extent, the high workloads can result in the violation of the nursing and medical principles that the nurses are to uphold. This includes the adherence to the rules and regulations of the nursing professions and medical care. As a result, the safety of the patient is put at risk. For instance, the negligence in the nurse’s duties not to wash the hands after an unhygienic activity may result in the spread of communicable diseases and or infections. This may further result in the dissatisfaction among the patients as the nurses are not able to provide enough and required time for them and the family members (Karasek RA, 1990). When the micro level is in focus, the demand factors as a result of the physical work which include the work requirements and the effort that the individual is to exert in his/her duties may have negative effects on the nurse. This includes the exposures to the ever changing and challenging work shifts and schedules in addition to the heavy lifting and being exposed to hazardous materials in the process of the provision of medical care and other related duties (Bathen S., 2004). The exposure to hazardous material and infectious substances may have a long lasting negative effect on the lives of the nurses and threaten their personal safety in addition to their livelihoods. Some duties may require heavy lifting and thus not all the nurses are able to perform these duties to the required levels. This may result in exhaustion and impact negatively on the performance levels (Greenglass ER, 2003). Political factors too can result in the burn out and lack of motivation among the nurses workloads. The lack of proper planning and allocation of funds due to ill advice and knowledge or empowerment may result in the diminished or poor allocation of resources that are aimed at enabling the nurses to lower their work load. In addition, the political turmoil and change in political institutions which are tribal or partisan could lead to some regions being neglected and thus lack the sufficient and required manpower and resources to effectively give the needed medical care to the needy patients (Burke RJ., 2003). This could negatively impact on the nurse workload if combined with the psychosocial and cognitive demands of work that are aimed at necessitating psychosocial capabilities and efforts. These factors include the communication skills, clinical knowledge and effective coping skills (Krayem A, 2006). Social factors too contribute heavily to the heavy workload of the nurses. The nurses often have limited time to interact with the outside world as they are often enclosed and interact most often with the persons they work with. The psychological trauma caused as a result of the events and scenes they witness and encounter in the course of their work which include disturbing and horrific episodes of dying, injured and traumatized patients always linger on their minds as most of them do not have a place where they can go for a debriefing. Their social life does not offer any help as the people they interact with have similar experiences thus not able to offer them with the required need. The essential services of a psychiatrist are normally limited and thus most often suffer burnout and mental challenges that impact heavily on their performance at work. The only persons they interact with apart from their counter parts are the family members who are often distant due to the limited time they have with each other (Krayem A, 2006). Generally heavy workloads have adverse effects on nurses in the world over and more so in developing countries. In the developing world the nurses do suffer technical expertise in handling the required machinery and systems that are aimed at decreasing their work load. This is as a result of the government not having a capacity building plan for the nurses as thy are few and this means if they have to go for any they are neither not replaced or no suitable person is readily available to provide the efficient services. These results into the profession to continue with the same old fashion of medical services as the new facilitates are of little or no use to them. On the other hand the field rarely has planned team building activities away from the hospital environment that would enable the nurses to have a different experience apart from the usual hospital environment (Krayem A, 2006).  I have noted that workloads on patients not only affect patients but also the universal nursing system as a whole as well as the specific organization where the nurse is working. Understaffing of nursing reduces the time in which nurse’s hand over duties leading confusion on the way new nurses are monitored and supervised. It has been an international concern on the increasing trend of nurses who drop their careers to join others due to increasing dissatisfaction (Sung-Hyun et al 2003).   There are many observable implications of nursing organizations towards the specific hospitals and other institutions. In my opinion, nursing workload is highly related to suboptimal patient care thus resulting to reduced patient satisfaction. Research within Australia indicates that there exist great relationship between hospital nurse staffing, patient safety outcome and general quality health care (Greenglass 2003). In my opinion, impact of nurse workload on patients is mostly focused in linking staffing intervals with patient outcomes. In order to ensure that the contemporary issue surrounding nursing workloads and patients safety there are several issues that need to be taken into account. Nurses should not be deviated from the work they are designed to undertake as stipulated in their policies, instruction, written rules and procedures (Hodge 2004).   Secondly, it has been proven that there are numerous implications of high nursing workload and this has been shown to have adverse effects on the safety of patients. As a result of this, grievances from nurses have been on the increase with many quitting from the career hence increased turn over and shortage of nurses in many countries. Dressman (2008) maintains that the main contribution of nurse’s workload is increase in the number of patients but other factors contribute as well. Noticeably, nurses are required to do other tasks such as washing and dressing patients, monitoring their eating regime, coordinating and performing subsidiary services and transporting patients in addition to their professional tasks which I have personally observed to be occurring in many hospitals. Heavy nursing workload leads to substandard patient care and consequently leads to increase in patient dissatisfaction (Heather, 2004). Thirdly, heavy workloads on nurses affect the organization in such a way that nurses cannot accomplish their various activities on a timely manner. It becomes difficult for them to perform procedures which influences care provision and decision making process of the hospital. In my opinion, this leads to a communication barrier between the nurse and the physician and between the nurse and the patients which adversely affects the quality of services in hospitals. Evidently, nurses experiencing large workloads, poor working conditions and job dissatisfaction have low morale, poor performance, absenteeism   which poses a potential threat to organizational effectiveness and overall patient care quality (Olofsson et al, 2003). Fourthly, I have observed that heavy workloads contribute greatly to organizational errors. These errors can be classified into two categories; knowledge or mistake errors and execution or slips and lapse errors (McGillis Hall, 2005). Nurses under time pressure tend to have reduced attention on safety-critical tasks which in turn creates channels for unsafe patient care and errors in the organisation. It is also quite noticeable that nurses with heavy workloads deliberately defy the rules and regulations governing professional medical practice set to maintain secure or safe operations. Nurses under time and work pressure have no time to follow rules and regulations which in turn puts the lives of patients at risk (Carayon and Gurses, 2007).     Finally, there are many negative implications of heavy workloads nurses personal lives .Evidently, many nurses have developed distress and burnouts whereby they become cynical, emotionally exhausted and angry. These nurses tend to become inefficient and less effective in their respective task which ultimately leads to reduction in their cognitive and physical resources. Patients care and safety are compromised in the process. Due to work pressure, many nurses lack sufficient time for their personal matters such as interaction with friends and family which adversely affects their social lives. In addition to this, there are increasing cases of nurses who commit suicide in many countries across the world. This has been directly attributed to lack sufficient incentive awarded to nurses and motivation as well as lack of mentorship. Clearly, violation of nurses’ job description is considered to be the root cause of nursing workload which leads to the minimization of patient safety. Carayon (2007) maintains that, it is very important that nurses are governed under both social and organizational context by way of operating under code of practice, regulation and rules as well as operating procedures. In effort to improve nursing workload and patient safety, it is important for hospitals and other health facilities to understand the link between adverse outcome and nurse workload. It is advisable that these facilities develop quality initiatives that will ensure quality methods and indicators are implemented so as nurses workload is minimized. The indicators may be in terms of giving full job description for the nurses and policies developed to ensure that nurses always perform duties that are within her/her specification (Hughes 2005). Further, through the use of opinions from the literature review surrounding nurses work load and patient safety, it is recommended that in order to reduce variation in nursing workload it is important for hospitals and health facilities to increase predictability which may exists in various staffing needs. Hughes, R. (2005) maintains that, this can be achieved by implementing smooth staffing level in nursing by way of determining numbers of nurses need within the health system then create a conclusive budget for the number of nurses in question. Similarly, a facility should supplement staffing levels as required especially widely focusing on patient acuity. According to the interview questions designed in the guide, it is quite evidence that nursing workload requires adverse measures so as to improve nursing performance within Australia as well across the world. In conclusion, reduced staffing and increased overtime, inadequate supply of nurses, increased demand for nurses and finally, reduction length on patient say contribute heavily to the heavy workload of the nurses according to the literature surrounding this issue. The heavy workload is that it adversely affects patient safety. Factors such as historical, political, social and economic are known impact on patient safety. Nurses under this immense pressure tend to have reduced attention on safety-critical tasks which in turn creates channels for unsafe patient care and errors in the organisation. It is also quite noticeable that nurses with heavy workloads deliberately defy the rules and regulations governing professional medical practice set to maintain secure or safe operations. Deliberate efforts are thus required to reduce the nurses’ heavy workload for a meaningful and efficient healthcare provision. References Carayon P, A. C. (2007). Workload and patient safety among critical. Crit Care Nurs Clin North Am , 19:121e9. Carayon, P. (2006). Work system design for patient safety: the SEIPS model. Quality Safety Health Care; 15:50-8. Carayon, P. (2007). Evaluation of nurse interaction with bar code medication administration technology in the work environment Journal of Patient Safety;3(1):34-42. Carayon, P. and Gurses, A.(2007). Chapter 30Nursing Workload and Patient Safety—A Human Factors Engineering Perspective. Retrieved on 6th September 2011 from http://www.ncbi.nlm.nih.gov/books/NBK2657/ Darvas, J. (2002). What makes a good intensive care unit: a nursing perspective. Australia Critical care; 15(2):77-82. Davis, S. (2003). Communicating with families of patients in an acute hospital with advanced cancer: problems and strategies identified by nurses. Cancer Nursing; 26:337-45. Dressman, A. (2008). Distractions and the effects of distractions on nurses' abilities to appropriately assess patient status and prevent adverse events. M.A. : Northern Kentucky University. Greenglass ER, B. R. (2003). Reactions to increased workload: effects on professional efficacy of nurses. Appl Psychol: An International Review , 52(4):580-97. Heather, K. (2004). Hospital Nurses' Perceptions of Respect and Organizational Justice. Journal of Nursing Administration: July/August 2004 - Volume 34 - Issue 7-8 - pp 354-364 Hodge, M. (2004). Nurse-patient ratios: a systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes. Journal of Nursing admissions: 34(7-8); 326-37. Hughes, R. (2005). Working conditions that support patient safety. Journal of Nurses Care Quality; 20(4):289-92. Karasek RA, T. T. (1990). Healthy Works: Stress, Productivuity and the Reconstruction of the Working life . New York : Basic Books. Krayem A, B. R. (2006). Ann Thorac Med. Unplanned extubation in the ICU: , 71-72. Manage , 22:99-107. McGillis Hall, L. ( 2005). Quality work environments for nurse and patient safety. Sudbury, Mass. : Jones and Bartlett Publishers. Olofsson, B.,Bengtsson, C. and Brink, E.(2003). Absence of response: a study of nurses' experience of stress in the workplace. Journal of Nursing Management. Volume 11, Issue 5, pages 351–358 RJ., Burke. (2003). Hospital restructuring, workload, and nursing staff. Health Care S., Bathen. (2004). Nursing ratios. State Net California Journal , 52-54. Sung-Hyun, C., Shaké, K., Violet H. and Dean, G. (2003). The Effects of Nurse Staffing on Adverse Events, Morbidity, Mortality, and Medical Costs. Nursing Research. Volume 52 - Issue 2 - pp 71-79. Read More