The Nursing Shortage: Patient Care, Staffing, and New Nurse Transition

Central New Mexico Community College

The topic of my choice that I have researched is the nursing shortage that I see during my clinical rotation. There are not always enough nurses on the floor for the acuity of patients who are admitted. The articles I reviewed give reasons on why the shortage exists, how it affects patient care, and how to help new RNs transition into the new role of Registered Nurse. The areas of improvement would be to hire more nursing faculty to teach qualified individuals to advance their training, not to burn out the nurses by giving them a high patient-to-nurse ratio, and building the relationship of new nurses with their preceptors to be able to grow.

Impact of Nurse Shortage on Patient Care and Safety

Patient safety and quality of care are being affected by the shortage of nurses. This is not a recent problem; it has been going on for many years. In fact, the legislation passed the Nurse Reinvestment Act in 2002, the Registered Nurse Safe Staffing Act of 2007 and 2010, and mandated nurse ratios at the State level to encourage nursing growth. The Registered Nurse Safe Staffing Act of 2010 states that it must be based on patient numbers and the intensity of care they need to take into account the level of education, training, and experience of the RNs providing care, ensure that RNs are not forced to work in units in which they are not trained and must consider other factors affecting the delivery of care, including unit geography and available technology.

The bill would also protect RNs and others who may file a complaint about staffing, allow for the refusal of an assignment, and establish procedures for receiving and investigating complaints.” (The American Nurses Association, 2010, p. 2) (Martin, 2015, p. 4). The more nurses available at the bedside, the greater patient satisfaction, improvement of quality of care, an increase in the morale of the nurses, greater job satisfaction, and greater retention rate for the employers. Staffing inadequacy questions the ethical principles of Beneficence and non-maleficence of the nurse by putting patient safety and how they care for a patient at risk. These two principles are the backbone of the way nurses practice. It is not only morally required but legally as well. Not being able to manage the workload and nurse fatigue can cause the disregard of these principles.

Consequences of High Nurse-to-Patient Ratios and Educator Shortage

A high nurse-to-patient ratio is directly responsible for nurses’ job-related burnout and job dissatisfaction. Adverse outcomes of a high nurse-patient ratio include pneumonia, cardiac arrest, shock, and UTI. Lower registered nurse-to-patient ratios are shown to reduce mortality rate by more than 50%” (Sofer, 2005, p.20). (Martin, 2015, p. 4). A workload that is not realistic can result in chronic fatigue, poor sleep patterns, absenteeism, and job dissatisfaction. What some organizations in California have done is they will have more RNs on staff and less unlicensed assistive personnel (UAPs). That, in turn, changes the RN’s duties, which would include housekeeping and transportation. The purpose is not to get rid of ancillary staff but to add more nurses who can care for patients.

One of the reasons that there is a nursing shortage in the State of Texas is because of the lack of nursing educators. The average age of a nurse educator in the United States is 56.4. (Allen et al., 2017.) Retirement for the educators is expected to increase. According to a report from the American Association of Colleges of Nursing, nursing schools turned away 68,938 qualified applicants from baccalaureate and graduate nursing programs in 2014 due to faculty shortage. In the same year, it was found that there were 1,236 faculty vacancies in baccalaureate and graduate nursing programs. In 2015, the National League of Nursing faculty census survey found there were 1,072 faculty vacancies in all types of nursing schools. (Allen et al., 2017.)

Fostering Successful Nurse Transition and Retention

The transition between a Nursing Student and an RN is facilitated by structure and socialization. The structure consists of new Graduates having a safe environment where they are able to share experiences and ask for guidance. Socialization has a support system that includes a nurse educator, preceptor, and fellow staff. According to The University of New Mexico, 17.5% of newly licensed nurses only work for one year, while 43% of newly licensed nurses leave the hospital within three years of starting. (Blevin, 2018 p.199).

Encouragement is needed for new nurses; having a trusting relationship with the preceptor and nurse educator can promote communication if there is lateral violence in the workplace. It is important to have consistency with preceptors because new nurses can feel like they are being bounced around if there are multiple preceptors. Having this consistency helps the new nurse build their confidence and helps the preceptor provide feedback and opportunities to grow.

References:

1. Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing, 24(2), 4–6. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103796942&site=ehost- live&scope=site
2. Allen, P., Sportsman, S., Batchellar, J., Boswell, C., Cannon, S., Evans, M., Starlin, M., Valerio, J. (2017). THE NURSING FACULTY SHORTAGE: What Is Being Done in Texas? Texas Nursing, 91(3), 12–14. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=125191895&site=ehost- live&scope=site
3. Blevins, S. (2018). From Nursing Student to Registered Nurse: The Challenge of Transition. MEDSURG Nursing, 27(3), 199–200. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=130397407&site=ehost- live&scope=sitec