Organizational Policies and Practices to Support Healthcare Issues

Main Discussion Post

Patient’s experiences are being monitored by healthcare institutions to help evaluate and improve the quality of care. Patient’s experiences are impacted by nurses. Nurses spend the most time with patients and are the vital element to improving quality patient care and experiences because they know what factors influence the work environment (Kieft, Brouwer, Francke, & Delnoij, 2014). There has been an increase in focusing on and dealing with workforce issues in organizations globally (Bridges & Meyer, 2007). It is essential for nurses to possess the ability to identify any ethical problems they come across. Moral action is the first process in the direction of recognizing ethical implications (Milliken, 2018). Kelly and Porr state, “Registered nurses (RNs) are constantly challenged to provide quality nursing care while resources are chipped away, sometimes along with their energy, pride, and ability to provide holistic patient care. Many experience frustration and a sense of powerlessness to change their circumstances (2018).

During this COVID-19 pandemic, there have been many speculations and trials and tribulations in managing and addressing this virus. What was initially thought to be an “elderly” disease turned out to be a disease that didn’t discriminate against sex, age, or race. The whole world went into a panic. Healthcare workers stressed and fearful of how we were going to combat this disease while keeping ourselves safe and protected.

In the beginning of the pandemic, we had a couple of cases on our unit that are considered PUIs (patient under investigation). I was one of the first to care for these patients. At the time, testing kits were scarce and the time for results to come back took a minimum of 5 days. During the time I was caring for the patient, I was not provided with proper PPE. I had a surgical mask and gown. There were no N95s, goggles, face shields, hair or shoe covers. Doctors actually told me that I do not need an N95 and that my surgical mask is sufficient. I believe it had to do with the shortage of N95 because I could not get my hands on one even if I wanted to. My anxiety was high. I worried about getting infected and bringing it home to my children, especially my child with type 1 diabetes. I was also concerned about my other patients that I was caring for.  I was on the verge of tears. Despite my fear and extreme anxiety, I cared for the patient throughout the night.  We were supposed to rotate caring for PUIs, but the rotation was quick and short. Before I know it, it was my turn again. Many nurses went on stress leave which made us short staff. Nurses are already in a high-stress environment, therefore piling on additional stress may result in nurse burnout (Maben & Bridges, 2020). Despite several complaints and cry for help, the unit manager refused to hire more nurses. We didn’t think caring for PUIs and non-PUIs are safe and effective. Not only are putting other patients at risk, but the quality of care will also diminish and unethical. “Effective nursing leaders confront ethical dilemmas by demonstrating moral leadership” (Laureate Education, 2018). We gathered together and demanded more and proper PPE.  Although, PUIs are basically “rule outs”, we have to treat it like they are positive. We also suggested to management that it would be more beneficial to all patients if we change the acuity to a one to one. We can be the primary nurse, housekeeping, labs, and PCA. This way we can eliminate unnecessary exposure to other employees and patients and also provide high-quality care. As a result of our relentless requests and engagement with management, we were able to meet our needs. We were provided with N95 masks and although we have to reuse it, we felt more protected than before. This does mean we no longer have fear and anxiety, but it helps eliminate the added stress.

References

Bridges, J. & Meyer, J. (2007). Policy on new workforce roles: A discussion paper. International Journal of Nursing Studies, 44(4), 635-644. Elsevier

Kelly, P. & Porr, C. (2018). Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice. OJIN: Online Journal of Issues in

Nursing, 23(1), Manuscript 6.

Kieft, R.A., Brouwer, B.B., Francke, A.L., & Delnoij, D.M. (2014). How nurses and their work environment affect patient experiences of the quality

of care: a qualitative study. BioMed Central, 14, 249-255.

Laureate Education (Producer). (2018). Moral Leadership (Video file). Baltimore, MD: Author.

Maben, J. & Bridges, J. (2020). Covid‐19: Supporting nurses’ psychological and mental health. JCN: Journal of Clinical Nursing.

https://doi.org/10.1111/jocn.15307

Milliken, A. (2018). Ethical Awareness: What It Is and Why It Matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1.

Discussion: Organizational Policies and Practices to Support Healthcare Issues

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.

To Prepare:

  • Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
  • Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.

By Day 3 of Week 3

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

By Day 6 of Week 3

Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.

Your post hits home for me. I have experienced some of these same struggles at my place of employment as well. I was also the first nurse on my unit to care for a PUI, however, this was at the beginning of March when PPE supplies were in greater numbers. It’s very interesting how policies change according to what is available to work with. After we cared for this patient, our management and house supervisors stated that if we were to get more PUI that every patient room would be converted to negative airflow. That never happened. As time went on, we converted from a medical ICU to a COVID ICU. Concerns about staffing and supplies grew as every day passed. We all knew that we needed more nurses, but we didn’t know if management was willing to listen.

RNs may experience tension when they are faced with what the right thing to do is versus their hospital policy, thus causing ethical distress, which could interfere with providing safe and ethical nursing care (Kelly & Porr, 2018). Being unable to provide safe nursing care with staffing shortages became increasingly challenging. We asked for more nurses to be hired so we could deliver the care the patients needed. Weekly Webex meetings on the phone were set up with higher management and all employees so we could voice our concerns. Our management ended up hiring travelers to fill open positions. We realized that the more people we got to speak up about how our staffing shortage was affecting patient care, the management might be more engaged to help. By making these ethical complications known it can better ensure that patient needs are met (Milliken, 2018). I’m glad you were able to get the needs met for the benefit of your patients and yourselves because providing safe and ethical care is what we are all here to do.

Kelly, P. & Porr, C. (2018). Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. Doi: 10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAperiodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Milliken, A. (2018). Ethical Awareness: What It Is and Why It Matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. Doi: 10.3912/OJIN.Vol23No1Man1. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html

 

Geat post, people do not understand what we go through as nurses on a daily basis. Nurses are the center of the whole patient care. Nurses deal with family, doctors, case managers and all other departments. They look at nurses for all the solutions and all the answers. So it is already a stressful job and to add a pandemic to the mix and lack of resources just makes it worse. Covid-19 has put a big strain on health care and staff. Work-related stress can be damaging to a person’s physical and mental health, while its’ high levels have been related/connected to high staff truancy and low levels of productivity (Sarafis, Rousaki, & Tsounis, 2016). Almost every nurse I talked to was burnt out and still are. Even though COVID-19 has slowed down it is still stressful. Stress and burn out to staff effects not only the staff but also effects patient outcomes. Findings clearly indicate that nurse burnout is associated with increased odds of reporting negative patient outcomes (Nantsupawat, 2016).

References

Nantsupawat, A., (2016). Nurse burnout, nurse-reported quality of care, and patient outcomes in

Thai hospitals. Journal of Nursing Scholarship, 48(1), 83-90.

doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1111/jnu.12187

Sarafis, P., Rousaki, E., & Tsounis, P., (2016). The impact of occupational stress on nurses

caring behaviors and their health related quality of life. BMC Nursing, 15

            doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1186/s12912-016-0178-y

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