Category: Solved Questions

• Pathophysiology of neurotransmitter involvement with psychosis disorders
• Functions of Brain Regions
• Psychopharmacology uses for psychosis disorders, including side effects, therapeutic levels, appropriate dosing
• Be familiar with diagnostic criteria from DSM-5 for psychosis disorders, prevalence, and treatment options
• Be familiar with psychosexual development and sexual dysfunction/paraphilic disorders; DSM-5 diagnostic criteria, characteristics for the disorders, treatment options
• Understand different types of personality disorders: DSM-5 diagnostic criteria, characteristics for the disorders, treatment options
• Understand neurotransmitter involvement, symptoms, and treatment for medication-induced movement disorders
• Know how to differentiate between substance use disorders, DSM-5 diagnostic criteria, prevalence, and treatment options
• Be familiar with Dissociative and Cognitive disorders
• Be familiar with psychiatric emergencies, including characteristics, prevalence, and prevention of suicide

Introduction
The Earth’s oceans contain nearly 97% of the planet’s water and cover nearly 70% of its surface. Like the atmosphere, they play a critical role as one of the Earth’s major systems. Ocean waters have contrasting properties and are subject to complex processes that are often tied to the behavior of the atmosphere or are impacted by the same controls as those that affect the atmosphere. The text and exercises in this lab are intended to introduce you to the fundamental properties and behavior of the Earth’s oceans and
how they can be measured and interpreted

Geography
Before examining the properties and behavior of the world’s oceans, it is helpful to have a good grasp of geography. Different bodies of water have different characteristic and are subject to different controls and processes. Some bodies of water are distinct, but most of the ocean water is connected – the water of the four major ocean basins is in direct contact with numerous seas, bays, and gulfs. There can be bathymetric boundaries which separate named water bodies (basins) as well as boundaries defined by currents. The Southern Ocean, for example, is an unofficial designation for the waters off the coast of Antarctica. This “ocean” is defined by the Antarctic Circumpolar Current which separates cold Antarctic
waters from the warmer waters of the of southern Pacific, Atlantic, and Indian Oceans. For the most part, the names of water bodies reflect cultural preferences and the priority given to first discoveries. If the name becomes part of a culture’s vocabulary, it will continue, regardless of whether the name is technically accurate. (The Gulf of Mexico could easily be considered a sea in its own right. In fact, many countries argue that the Persian Gulf should be renamed the Arabian Gulf.) Regardless of what they are called, knowledge of the actual location of particular features of the world sets a baseline for important geography applicable to many classes and serves as a first entry into the world of oceanography, setting the stage for discussions of ocean currents, thermohaline circulation, and plate tectonic evolution. Because the two are so closely linked, any discussion or study of the oceans relies on first understanding how the atmosphere functions. Circulation within both the atmosphere and ocean relies on energy radiated from the Sun (Figure 1a). Because the Earth is a sphere, insolation (incoming solar radiation) does not evenly strike the planet. Around the Equator, insolation strikes at a higher angle, delivering more energy per unit area. Toward the poles, because of the curvature of the Earth, insolation strikes at a lower angle. This spreads insolation out over a larger area, resulting in less energy delivered per unit area. The difference in insolation angle results in an imbalance in heat energy between the Equator and the poles. Currents exist in both the atmosphere and the oceans to redistribute heat in an effort to
correct the energy imbalance. The heat absorbed from the Sun by the Earth’s surface drives vertical circulation within the atmosphere (Figure 1b). When air is warmed it spreads out, becoming less dense. If an airmass is less dense than the surrounding air, it will begin to rise through the atmosphere. When air rises, it creates an area of low atmospheric pressure near the ground (lifting air lowers weight). As the air mass rises, it expands because of lower atmospheric pressure aloft. The expanding air must perform work to occupy that larger volume, so it releases energy and cools. As the airmass cools, its relative humidity will increase.
Once the airmass cools to its dew point, clouds and eventually precipitation can form. In order to condense from a gas into liquid, the water vapor in the airmass must release heat energy. This can cause the airmass to cool relative to the surrounding air. When this happens, the airmass will begin to sink because it will be denser (cooler) than the surrounding air. As the airmass sinks, it is compressed due to higher pressure near the Earth’s surface. This causes the volume of air to warm. As
the sinking air warms, its relative humidity decreases, creating a region of drier, clear air. The sinking air
also creates an area of high atmospheric pressure near the ground (sinking air increases weight).
The basic circulation process described above can happen at a global scale (Figure 1b). Low-pressure
regions with rising air tend to form at the Equator (0° – Equatorial Low) and near the temperate regions
(60°n/s latitudes – Subpolar Low). Globally, these regions tend to have abundant cloud cover and rainfall.
High pressure regions with sinking air tend to form in the Subtropics (30°n/s latitudes – Subtropical
High) and at the Poles (90°n/s latitudes – Polar High). Globally, these regions tend to have clear, dry
conditions with high evaporation rates.
The pressure zones that are associated with precipitation conditions (low’s rainy; highs dry) also
generate surface winds (Figure 1c). At the Earth’s surface, winds blow high pressure zones toward low
pressure zones (known as the pressure gradient force). Because the Earth is rotating, these longdistance winds are impacted by the Coriolis effect so that they are deflected to the right of the pressure
gradient force in the northern hemisphere and to the left in the southern hemisphere. The winds blow
from the Subtropical High (30°) toward the Equatorial Low (0°) are deflected so that they consistently
travel from east to west. This belt of easterly winds that encircles the globe are known as the Trade
Winds. From the Subtropical High (30°) to the Subpolar Low (60°), the winds are deflected so that they
consistently blow to the west around the globe. This band of winds is the Westerlies. From the Polar
High (90°) to the Subpolar Low (60°), the winds are deflected so that they consistently blow to the east
around the globe. This band of winds is the Polar Easterlies. The end result of the winds trying to blow
from high to low pressure but experiencing Coriolis deflection is a pattern of globally predictable
easterly and westerly winds.
GEOL 1401 – Ocean Circulation
3
Ocean Water Properties
A key property of ocean water is that it is “salt water.” Salinity is the total amount of ions (in grams)
dissolved in 1 kg of seawater, written either as a
percent (%, parts per hundred) or per mille (‰,
parts per thousand). Sea salt, as the chemical
precipitate from seawater is called, is different
from regular table salt in that it is not simply
sodium chloride (NaCl). Seawater can contain a
host of different ions from a variety of sources
(Figure 2).
Sea surface salinity varies with latitude (Figure 3)
because of the impact of global atmospheric
circulation patterns. Atmospheric high pressure
zones (Subtropical and Polar Highs) are associated
with dry air, high evaporation rates, and thus high
salinity ocean water. Low pressure
zones (Equatorial and Subpolar
Lows) are associated with rising
airmasses that produce abundant
precipitation. Rainwater will dilute
ocean salinity, creating patches of
slightly lower salinity ocean water.
Changes in salinity can also be
affected locally by freshwater inputs
from large rivers or seasonally
melting sea ice. Both processes lead
to slightly less saline ocean water.
Another key property of seawater is
its temperature. Like salinity, sea
surface temperature varies with
latitude (Figure 4). However, the
reason for its variability is not tied
to atmospheric circulation, rather it
varies with the angle at which
sunlight strikes the globe. Near the
equator, sunlight strikes the Earth
at a high angle all year long. This
high angle of incidence means that
a more heat energy is transferred
to the sea surface. Closer to the
poles, the angle of incidence is
lower, meaning that less energy is
delivered per unit of sea surface
area.
Figure 2: Seawater salinity and major chemical
components.
Figure 3: Global sea surface salinity
Figure 4: Global sea surface temperature
GEOL 1401 – Ocean Circulation
4
Whole (Deep) Ocean Circulation
The most critical ocean wide current is the density driven Thermohaline Circulation (Figure 6). In regions
where surface seawater is really cold, it can become so dense that it sinks to the bottom of the world’s
oceans (North Atlantic Deep Water and Antarctic Bottom Water – Figure 5). There it moves along the
seafloor until it reaches areas of upwelling that return the deep water back to the surface. This current is
critical to life in the oceans because is carries oxygen rich surface water to the seafloor, allowing life to
thrive at depth and allowing microbes to convert organic matter to nutrients. Without this process, the
ocean food web would collapse. The current is also responsible for moving warm water poleward and
cooler water toward the Equator in an effort to even out temperature differences created by the
difference in solar insolation between the regions.
Figure 5: South to north cross section of the Atlantic Ocean
Figure 6: thermohaline circulation
GEOL 1401 – Ocean Circulation
5
Surface Ocean Circulation
Ocean surface currents are wind-generated “rivers” of faster-moving ocean water that circulate
throughout the oceans, providing benefits (or detriments) to navigation, as well as having huge effects
one climate and weather. Like winds in the atmosphere, ocean surface currents are large-scale features
that are affected by the rotation of the Earth – the Coriolis effect. In the Northern Hemisphere, wind
blown currents are steadily deflected to the right of their initial path of travel; in the Southern
Hemisphere, they are deflected to the left. While these gyres can be broken into named segments, they
are one continuous current (Figure 7). The end result is the formation of large circular currents or gyres
that carry water clockwise in the northern oceans and counterclockwise in the southern oceans. This is
of profound importance to global climate as circulating ocean currents can drag warm water poleward
and cooler water toward the Equator in an effort to even out temperature differences created by the
difference in solar insolation between the regions. Because they bring with them either warm or cool
water, currents that wash into an area can also have a significant impact on local climate and weather
conditions.
Figure 7: Ocean surface currents

Would you expect the presence of labor unions to lead to higher or lower pay for worker members? Would you expect a higher or lower quantity of workers hired by those employers? Explain briefly.

I would expect the presence of labor unions to lead to high pay for worker members. Labor unions can negotiate favorable pay wages and terms. Also, when workers are in a union, they can unite and bargain for better pay and terms. I would expect labor unions to lower the quantity of workers since there would be more costs for the cost of employees. This would lead to some companies adopting automation or being too selective when hiring.

What are the main causes of the recent trends in union membership rates in the United States? Why are union rates lower in the United States than in many other developed countries?

Some factors leading to the recent trends in union membership rates in the United States include anti-union campaigns, such as intimidation from some companies, which discourage workers from joining unions. Some workers may also have the opinion that unions are for traditional jobs and are not helpful in the current world. Other factors include legal changes, which make it challenging for unions to maintain workers, and economic changes, which have changed the United States from a manufacturing hub. This sector was widely involved with labor unions. Union rates are lower in the United States because of various factors, including political, legal, and cultural factors. Politically, the United States does not support union membership, which impacts the legal frameworks. Current legal frameworks are less supportive. Culturally, the United States lacks labor solidarity.

What is a monopsony?

Monopsony is defined as a market structure where there is only a single buyer for a specific product or service offered by several sellers. Such buyers have high market power and can influence the price and quantity of the product or service involved.

What is the marginal cost of labor?

The marginal cost of labor is the additional cost or expenses that an employer incurs when hiring one more unit of labor, in most cases, an additional employee. The marginal cost helps firms understand the optimal level of employment of a company as they seek to keep the marginal cost lower than the additional revenue generated by the extra worker.

How does monopsony affect the equilibrium wage and employment levels?

A monopsony market lowers the wage level as the employers can set the employee wages. The wages are lower than the wages that could be set in a competitive market. Besides, such employers would hire fewer workers as they face an upward-sloping supply curve of labor.

What is a bilateral monopoly?

A bilateral monopoly is when a single product or service buyer has a single seller. The seller acts as a monopoly, seeking to gain high prices from the buyer, and the buyer seeks ways to pay low prices. Each of the parties has significant negotiating power.

How does a bilateral monopoly affect the equilibrium wage and employment levels compared to a perfectly competitive labor market?

Wages in a bilateral monopoly are determined through negotiations between the two parties, as they both have high negotiating power. Unlike in a perfectly competitive market where wages depend on demand and supply forces, such wages are influenced by the relative bargaining strength of the teams and the willingness of the buyer. The number of workers hired depends on the agreement between the two parties, unlike in a competitive labor market. Such negotiations may also lead to less efficiency.

Describe how the earnings gap between men and women has evolved in recent decades.

Traditionally, women were only involved in traditional roles and low-paying jobs. The gender pay gap was huge until around the 1970s when legal and societal changes led to several women joining the workforce and accessing higher education, which opened several career opportunities for women. Nevertheless, the pay gap persisted as there were limits to women getting job positions. Recently, the gender pay gap has been proven to narrow, but women are still the majority in low-paying jobs and are usually not represented in high-paying jobs.

Use the HEENT write history and physical assessment template to document your write-up.  One thing to pay attention to with the write-up is the difference between the ROS and the PE.  Many students get these confused and end up missing a significant amount of points.  Remember the ROS subjective; it is what the patient tells you.  This will be documented as ‘denies’.  i.e. “Denies change in hearing”.  The PE is the objective information.  It is what you see during your physical exam.  Also, avoid using the term ‘normal’.  There is almost always a more descriptive way to report your physical findings.

Northern Kentucky University

MSN 610: Diagnostic Reasoning and Advanced Physical Assessment

 Comprehensive History & Physical Exam

DEMOGRAPHICS

Providers Name: ____________Patient’s Initials: (Data Source)___________

Date of Exam: _______________Patient’s DOB/AGE: _______________

Chief Complaint: ___________Gender/Sexual Orientation: _____________

History of Present Illness:

 

Past Medical History: 

               Active Problems:

Resolved Problems:                           

Previous Hospitalizations:

 Surgical History:

Allergies:

Current Medications:

Social History:

Living Arrangements:

Occupation:

Environmental Safety:

Smoking:

Alcohol:

Drugs:

Diet:

Other Non-Prescribed Drugs:

Family History: 

Relationship Living or Deceased Age Illnesses

 Preventative Health/ Anticipatory Guidance: (Age Appropriate) 

1. Safety Issues:

2. Screenings:

3. Immunizations:

Reproductive health:

Review of Systems:

General:

Skin, Hair, Nails:

HEENT:

Neck:

Cardiovascular:

Pulmonary:

Abd/GI:

Genitourinary/ Gynecology/ Breast:

Musculoskeletal:

Neuro:

Endo/Lymphatic:

Hematology:

Psych:

Physical Exam

Vital Signs:           Temp: __________   Pulse: _______    BP:   _________/________  Resp: ______         O2 sat: _________

General:
Head:
Ears:
Eyes:
Nose:
Throat:
Neck:

 

Assessment Statement:  

Problem List (As many or as few as needed)

Include ICD – 10 CODE

1.

2.

3. 

Plan: 

1.

2.

3.

4.

Submitted by: __________________________________________________

Date: __________________________________________

 

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Criteria	Ratings	Pts
Provider’s Name	1 pts Full Marks 0 pts No Marks	1 pts
Patient’s Initials	1 pts Full Marks 0 pts No Marks	1 pts
Date of Exam	1 pts Full Marks 0 pts No Marks	1 pts
Patient’s DOB & Age	2 to >0.0 pts Full Marks 0 pts No Marks	2 pts
Patient’s Gender & Sexual Orientation	2 to >0.0 pts Full Marks 0 pts No Marks	2 pts
Chief Complaint	1 pts Full Marks 0 pts No Marks	1 pts
HPI (onset, symptoms–location, quality, quantity, timing; setting, aggravating or alleviating factors, associated problems or symptoms)	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
PMH: hildhood diseases, adult diseases/medical conditions, accidents/injury history, immunization history	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Allergies (drugs, IV contrast, bandages, pollen, plants, food, animal, occupational)	3 to >0.0 pts Full Marks 0 pts No Marks	3 pts
Current medications	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Social History (smoking or tobacco use, ETOH, caffeine, substance abuse, education attained, occupation, marital status, children?, lifestyle/activity level, diet, sports/activities/leisure/hobbies)	10 to >0.0 pts Full Marks 0 pts No Marks	10 pts
Family History: Parents, siblings, children, grandparents (include ages, chronic medical conditions, malignancies, hereditary diseases, causes of death and age at death if applicable, suicide?)	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Reproductive & Sexual Health: First day of LNMP if applicable, date of first menarche if applicable, GPTPAL (if applicable), Libido issues?, STI history, contraception?	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Review of Systems (ROS): General: weight gain/loss, appetite changes, sleeping habits, fever, fatigue, weakness, general health	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
ROS: Skin: color changes, rashes, sores, pain, pruritis, hemorrhages, hair loss/pattern, changes in nails	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
ROS: HEENT: headache, migraine, vision changes, cataracts, diplopia, otalgia, otorrhea, hearing changes, rhinorrhea, epistaxis, sinus drainage/pain, sore throat, hoarseness, dental pain/missing teeth, jaw pain or clicking	10 to >0.0 pts Full Marks 0 pts No Marks	10 pts
ROS: Breasts: discharge, pain, enlargement, lesions, galactorrhea	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
ROS: Respiratory: Pleuritic pain, tachypnea, asthma/wheezing, bronchitis, COPD/SOB/wheezing, TB history/treatment, orthopnea, DOE, sputum production, hemoptysis	10 to >0.0 pts Full Marks 0 pts No Marks	10 pts
ROS: CV: chest pain, palpitations, pedal edema, cyanosis, claudication, phlebitis, hypertension, orthostatic hypotension, dizziness	10 to >0.0 pts Full Marks 0 pts No Marks	10 pts
ROS: GI: nausea, vomiting, diarrhea, anorexia, dysphagia, hematemesis, bloating, flatulence, abdominal pain, constipation, clay-colored stools, hemorrhoids, hematochezia, melena, jaundice, GERD/heartburn	10 to >0.0 pts Full Marks 0 pts No Marks	10 pts
ROS: GU: urinary frequency, dysuria, nocturia, flank pain, hematuria, penile discharge/vaginal discharge, incontinence (and details of same if positive), urinary retention, UTI hx, STI hx, fertility/contraception/orgasms issues or treatment hx	10 to >0.0 pts Full Marks 0 pts No Marks	10 pts
ROS: MS: muscle pain, joint pain, loss of function, decreased ROM, loss of strength, joint swelling, hx of fractures/dislocations, hx of trauma/surgeries, back pain	10 to >0.0 pts Full Marks 0 pts No Marks	10 pts
ROS: Neuro: dizziness, headache, sleep changes, syncope/near-syncope, paralysis, paresthesia, hx of LOC, hx of seizures, hx of loss of bowel or bladder control, loss of memory	10 to >0.0 pts Full Marks 0 pts No Marks	10 pts
ROS: Endocrine: polyphagia/uria, goiter, lethargy, hot/cold intolerance, nervousness, obesity, change in sex characteristics, amenorrhea, gynecomastia, flushing	10 to >0.0 pts Full Marks 0 pts No Marks	10 pts
ROS: Psychiatric: anxiety, depression, hallucinations (specify if positive whether auditory, visual, gustatory, olfactory, command), suicidal ideation, hx of suicide attempt, hx of involuntary commitment, homicidal ideation, delusions	10 to >0.0 pts Full Marks 0 pts No Marks	10 pts
Physical Exam: VS (temp, HR, BP, RR, O2 sat)	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Physical Exam: General: must be at least 3 items	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Physical Exam: Head: skull, scalp, face–shape, size, profile, symmetry, pain, meningeal signs?	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Physical Exam: Ears: Shape/symmetry of auricles, canals, TM, auditory testing (Weber, Rinne, whisper)	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Physical Exam: Eyes: visual acuity, visual fields, symmetry, drainage, eye position and alignment, PERRLA?, EOMI?, ophthalmoloscopy (red reflex, optic disc, vessels, papilledema, hemorrhages, retinopathy?)	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Physical Exam: Nose: external and internal, patent nares? drainage? sinus pain? turbinates? bleeding? olfacation?	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Physical Exam: Throat/mouth: jaw motion, lips, salivary glands, cheeks, tongue, teeth, gums, oral mucosa, pharynx, tonsils, uvula, soft/hard palate	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Physical exam: Neck: flexibility, shape, symmetry, goiter/thyroid, lymph nodes and name, trachea, auscultate carotids, JVD?	5 pts Full Marks 0 pts No Marks	5 pts
Assessment Statement: including at least 3 problems or education deficits Remember, this is where you discuss your findings both from the history and the physical exam, this is where you put your medical decision making–either why an intervention is needed or why there isn’t an intervention needed, it’s your “wrap up” as if you are talking to another medical provider.	15 to >0.0 pts Full Marks 0 pts No Marks	15 pts
PLAN: at least 3 steps to address the problem list write here next to at least 3 problems what you would do to address these, recommend to the patient, educate the patient, refer out to specialist, run tests, prescribe medication, etc. You don’t have to do all of these, but you have to write next to each problem what you would do	15 to >0.0 pts Full Marks 0 pts No Marks	15 pts
Your signature and date You have to sign every chart or documentation you do as a provider, and you have to write the date you sign it.	5 to >0.0 pts Full Marks 0 pts No Marks	5 pts
Total Points: 226

1) Two types of dating for geologic materials:
1. a) _________ relative dating ____________________________
2. b) _________ absolute dating ____________________________
2) The Law of _______ superposition ___________________________ states that in any undisturbed sequence of strata the oldest rock layer is on the bottom and the youngest is on top.
3) The Principle of _________ fossil succession ____________________ says that fossils succeed each other in a definite and determinable order.
4) _______ inclusions _____________________________ are pieces of one rock unit that are contained within another unit. These pieces are older than the rock unit they are within.
5) The principle of cross-cutting relationships states that whenever a fault or intrusive igneous rock cuts through an existing feature, it is ______ younger ______________________ than the structure it cuts.
6) The principle of ___________ original horizontality __________________________ says that sediment forms layers and if those layers are folded or inclined that occurred ______ after ______________________ (after or before) deposition.
7) What are the three types of unconformities?
1. a) _______ disconformities ________________________________
2. b) _______ nonconformities ________________________________
3. c) _______ angular unconformities ________________________________
8) The amount of time it takes for half of a radioactive nuclei (___ radioactive ___________________ isotope) in a sample to change to their stable end product (_____ stable ________________ product) is known as the __________ half life ________________________ of the isotope.
10) Isotopes of an element have the same number of ______ protons _______________________, but a different number of ______ neutrons _______________________________.

continental slope – steepest part of the ocean floor
continental shelf – broad and flat, adjacent to th
continental rise – a sloping wedge of sediment
abyssal plain – flat and in deep water, seamo
trenches – deep, narrow, depressions a
mid-oceanic ridge – large undersea mountain ran
guyots – rise from the seafloor and are
There are two types of continental margins. The Atlantic Ocean is a/an __ passive __ continental margin and the Pacific Ocean is a/an __ active __ continental margin.

How Competing Needs Impact Policy Development

     The ability to provide widespread access to health services while raising the quality of care and managing costs is a critical problem for healthcare systems worldwide. Most medical professionals are adamant about providing high-quality care (Kelly & Porr, 2018). Various factors influence the demand for of registered nurses. The detrimental effects of the current nursing practice environment on the field’s ability to attract new students and the retention of registered nurses are particularly concerning. Companies are having to adjust the policies more often than before in order to keep current nurses and try to attract new ones. These policies are made by management teams within the company in response to the needs that are verbalized by the nursing staff.

Competing Needs that impact the Nursing Shortage

     According to research in Milliken’s paper, nurses frequently feel unprepared to handle the ethical dilemmas they encounter in practice, which may lead to moral anguish and burnout. One strategy to address this issue is to guarantee that nurses have the resources necessary to handle challenging circumstances (Milliken, 2018). In order to solve issues and meet patient requirements, nurses must first be aware of any potential ethical consequences of their activities. The healthcare sector places many pressures on healthcare providers, including the difficulties of clinical work, time restraints, competing demands, a lack of control over work procedures and scheduling, and contradictory leadership responsibilities and connections (Bridgeman et al., 2018). Healthcare leaders must recognize when their staff is burning out or need additional help. Participating in policymaking by healthcare workers is nothing new. However, only some get involved due to high-stress levels and poor work-life and personal-life balance. It is vital, however, that nurses speak up and ensure that policymakers within their company hear the issues. This would be a significant factor in developing policies that would benefit nurses and all healthcare workers, leading to decreased burnout.

How can Policies Impact Competing Needs

     The issues nurses experience are misrepresented by the widespread belief that COVID-19 is to blame for their burnout and job loss. More correctly, the epidemic has brought attention to and magnified nurses’ long-standing professional difficulties. According to scientific consensus, understaffing, unfavorable workplace conditions, and the absence of solid ethical frameworks are the leading causes of nurse burnout and moral distress. Burnout and moral distress can contribute to one another’s development, although their underlying causes and effects differ. There is a consensus that burnout and moral anguish were problems caused by unfavorable working conditions long before the pandemic began (Schlak et al., 2022). Influence is the power to compel changes in beliefs, behaviors, and outcomes. One of the most significant and rewarding traits of leadership is having influence. All leaders must exercise caution when using this gift (Broome & Marshall, 2021, p. 334). Healthcare professionals must speak out about workplace issues and other challenges in order to make a positive impact on healthcare. Our legislators may create regulations that reduce nurse burnout and boost nursing retention if they actively listen to the requirements of healthcare employees. Our current employers must be made aware of these as well. Healthcare professionals have the power to improve the nation’s healthcare system. All they have to do is raise their voices.

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Competing Needs Impact Policy Development

Policy development often comes with many competing needs of the organization, patient needs, financial needs, staff needs, and ethical considerations, to name a few. Nurses are often caught in the crosshairs of implementing a policy while knowing it does not align with the best needs of each patient. One persistent theme with nursing care versus policy is that the business models often need to pay more attention to the needs of the patient and nursing judgment and education in seeking the best outcomes for the organization rather than the patient (Kelly & Porr, 2018). This can lead to conflict in care teams, personal or professional, and stimulate a decline in patient care or organizational growth.

Competing Need’s Impact on Mental Health Resources

Currently, 150 million people live in an area federally designated as having a mental health provider shortage (Weiner, 2022). Several issues impact the provider shortage seen in mental health. There need to be more residency positions available to train new psychiatrists, and business models are driving patient care to be less patient-centered and more business-centered. Rural communities face challenges in recruiting providers. Additionally, nursing burnout and turnover can be high in mental health, even before COVID-19. A factor in nursing burnout is that nurses often feel unprepared to mitigate the ethical issues they face in their day-to-day practice (Milliken, 2018).

Policy’s Impact on Competing Needs

Policies can have a significant effect on patient needs. Considering mental health populations, policies must be reviewed for ethical considerations, ensuring the policy is not infringing on patients’ rights. This population can be challenging to treat, often non-compliance with treatment regimens for a variety of reasons- homelessness, lack of financial ability to afford services, lack of understanding whether that is baseline cognitive function or impacted by current disease state, physical access to services, or simply no longer taking medications because they were feeling better. This population requires much follow-up to help reach their care goals. They may also need other services that the policies fail to acknowledge. An example comes from the unit I currently work in. It is a crisis observation unit that keeps patients in a safe setting while awaiting inpatient placement. The policies did not account for the need for a social worker. So currently, we share a social worker with several of the medical floors, which means we rarely, if ever, see a social worker. It was not accounted for. It is something highly needed to be added to our policy, and now we are changing the policy to include the social workers in unit operations.

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Competing Needs and Policy Development

Policy development can be a tricky feat. There are usually many stakeholders and communities that are affected by new policies and it is important to understand everyone’s needs to ensure allotted resources are divided fairly and accordingly. Many things come into play such as, Patients, providers, insurance companies, healthcare administrators and politicians (Stone, 2022, p. 20). The needs that are competing in relation to the lack of access to healthcare are the need for healthcare infrastructure and the need for quality healthcare.

Without adequate infrastructure available for behavioral health patients emergency rooms are inundated with patients who are holding for treatment facility beds and taking up valuable resources in the emergency departments for medical complaints and emergencies. Nursing staff is becoming overwhelmed with the patient loads and new facilities or processes need to be developed for nurses to prevent burnout. Without nurses speaking up for themselves and lobbying for change, administrators will continue to push their staff for monetary profits compromising patient outcomes (Kelly & Porr, 2018). Policy can address these needs by allocating funds for psychiatric facilities and behavioral health staff. New facilities need to be constructed to support the demand in certain communities. Behavioral Health urgent cares or holdings can be developed to relieve the patient load from emergency rooms resources as well as inpatient facilities being able to apply for grants to expand existing facilities to accommodate increasing demands (Atkinson et al., 2020. p. 5-6).

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Nurses constantly face the challenge of providing a high standard of nursing care to patients even though their resources can be minimal at times, which leaves them feeling frustrated and without any voice as their patient’s advocate (Kelly & Porr, 2018). A national healthcare stressor for many healthcare systems is nursing shortages and burnout. These two usually go hand in hand because the shortages of nurses create more of a workload for the nurses, which then leads to burnout.

Due to the aging population, the need for healthcare services has increased. The shortage of nurses can lead to high morbidity and mortality rates as well as errors (Haddad, et al., 2022). There has been an increase in registered nurses and advanced practice nurses over the years due to the aging population and need for healthcare however, due to the increase in demand for healthcare, this can cause turnover and burnout in the healthcare providers (Broome & Marshall, 2021). The shortages we face can hinder the development of policies aimed at creating a better working environment for nurses. If the healthcare systems do not have the appropriate resources, they require for development of policies these get set aside until the need is met. How can a healthcare system put a policy into place if it doesn’t have the workforce to carry it out?

Nursing burnout and shortages are an issue across all healthcare systems today. The healthcare systems are trying to develop strategies to combat the shortages and avoid burnout in their nursing staff. The needs to combat this national healthcare issue include the need for increased workforce and resources. Healthcare systems have already begun putting recruitment efforts in place such as the use of travel/agency nurses, sign-on bonuses, and other incentives to attract more nurses to their facilities. There is also the competing need of practice authority varying from state to state. This creates roadblocks for advanced practice RNs in some states that have restrictions (Broome & Marshall, 2021). Some professional organizations support the idea of mandating a DNP for all advanced practice RNs by the year 2025 which can create more of a problem with the shortage issue solely based on the time it takes to obtain a DNP degree (Broome & Marshall, 2021). I am not so sure that policy will address these issues in a positive way unless it moves away from this requirement. If more states were to get rid of the collaborative agreement for advanced practice nurses, this type of policy change could help the shortages of providers in some states.

When it comes to registered nurse staff in healthcare systems and the shortages they face, policy changes such as the education and experience requirements that some facilities require could assist in the hiring of nurses to help the shortages they are experiencing. Some healthcare systems require you to have so many years of experience in a certain specialty in order to work there. For example, some emergency departments or labor and delivery units require nurses to have at least one year of experience in that specialty in order to be hired. If policy could change in the way of hiring more graduate nurses and training them to the specialty, it could help the shortage. Either way, there needs to be some wiggle room with these healthcare systems so this national healthcare stressor can be managed better. The nurses that are left dealing with this firsthand are getting burned out and exhausted while working short staffed.

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Needs of the workforce, resources, and patients makes an impact on the development of policies. Policies are created by upper management who are responsible for keeping up to keep with changes and activities related to policy. Nursing leaders should be aware of health policy so that they can provide input to nursing management and help with the changes that would affect reforms in health care policy (Broome and Marshall, 2021).

Changes in workforce and patient load lead to changing policies with staff to patient ratio. When I first started nursing night shift nurses only could take 4 patients at night on the cardiac floor and now that policy has changed to nurses taking 6 patients per nurse. Resource policy changes as well when supply is low for certain resources such as cleaning supplies for the floor. Different products are used, or different cleaning methods are created to help with the problem.

COVID-19 lead to many changes in policy that were related to staffing and resources. Bedside nurses experienced them the most and policies were changing daily. A Korean study focused on health care policy reform due to its population being older and changes with COVID-19 changed their whole health care system due to COVID-19 affecting the older population more. They didn’t have enough nurses for the increase in patients they were experiencing and in Korean healthcare families play a big part in caring for their loved ones in the hospital. Having more family involvement lead to increased exposure in hospitals. Bedside nurses became involved politically and lead health care policy reform through civic organizations to help resolve visiting and staffing policies during COVID-19 (NamKyung, 2020).

Resource policy changed with COVID-19 due to there not being enough resources such as PPE for staff. The US Centers for Disease Control and Prevention allowed an autoclave sterilization process to be used for N95s due to the reasoning of there being a crisis capacity level. This process used a 70% ethanol treatment, and it was determined that this process did comprise the filters breathability (Grinshpun et al., 2020). Methods like this were used even with limited data because it was safer than nothing at all for frontline workers.

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Healthcare is a vital field that provides citizens with healthcare and medical services. Despite its vital role, healthcare is rather a stressful working environment, and proper management of healthcare facilities is a difficult task to do. The medical staff consists of various personnel, and nurses are the most underestimated part of medical facilities. Additional ethical dilemmas for nurses during their duties are rather stressful and harm their efficiency.

In the modern healthcare system, the nursing staff plays an important role by assisting patients and monitoring their health conditions. Also, nurses act as a link between medical doctors, patients, and their families. In the modern American healthcare sector, nursing staff interacts with patients even more than professional doctorate staff. In the contemporary situation, nurses are not secondary, but additional and important medical staff. According to Milliken (2018), nurses are exposed to various ethical dilemmas that affect their overall efficiency and harm healthcare services. The key ethical issues are patient autonomy, confidentiality, allocation of resources, and enormous workload. Milliken (2018) found that current educational frameworks for nursing staff ignore ethical threats, and during real-life duties, most nurses feel unprepared to manage ethical challenges. The enormous workload is a serious problem because it has a national scale, and in the long-term run leads to professional burn-out and retirement from the profession (Kelly and Porr, 2018). Healthcare managers should do their best to avoid overload and additional work shifts for nursing staff. Undoubtedly, all medical staff understands the unstable nature of this profession and the necessity of extra shifts during emergencies, but human beings are not robots and overload leads to a lack of efficiency and mistakes.

The enormous workload of medical personnel is a very dangerous issue that leads to professional burnout, retirement from the profession, and further shortages in the medical labor market. Healthcare managers should use all their skills to avoid extra shifts that reduce overall efficiency and lead to mistakes. In the healthcare sector, mistakes could be fatal and healthcare managers should eliminate all possible risks.

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Organizational Policies

The healthcare issue I chose to focus on was nurse practitioner autonomy.  While many states have adopted independent practice for mid-level providers such as PAs and NPs, others require a practice agreement with a physician.  These practice agreements usually cost money and must be renewed in a specific time frame.  The NPs must follow their state license guidelines for procedures and prescribing authority. However, ethical conflicts in the workplace are commonplace in the nursing profession due to conflicting organizational logistics and policies and quality of care (Kelly & Porr, 2018). These ethical conflicts can spread to NPs when they know they can ethically improve access to healthcare and decreases costs if they were allowed to practice independently nationwide which would allow organizations to adopt different organizational policies.

Competing or Common goals

While organizational policies might require a physician agreement, changing laws nationwide would greatly impact the costs and provider burnout in individual institutions.  For example, without the physician agreement requirement, NPs would be able to practice more independently greatly reducing the strain on the healthcare staff in the organization. Likewise, nurse practitioner labor is cheaper than physician labor which would decrease healthcare costs.  This should be seen as a common goal that by allowing NPs to practice independently, healthcare costs would be reduced.  If an organization does not provide the resources to provide quality care to save money, this can lead to ethical conflicts amongst the healthcare staff (Kelly & Porr, 2018).  However, by ensuring that NPs can practice independently, it would save healthcare institutions money and improve access to quality healthcare overall.

Conclusion

            Providing the best quality care possible should be the goal of every organization that has a healthcare function.  Occasionally what is ethical sometimes conflicts with organizational needs. However, ethics is at the center of everything that nurses do (Milliken, 2018). Removing practice agreements for NPs nationwide will allow greater access for patients to access quality healthcare, would help reduce healthcare costs due to various reasons, and therefore would allow for more ethical healthcare solutions.  Specifically, APRNs are poised to address social determinants of health and provide opportunities for underserved populations to access healthcare (Heath, 2022).

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Competing needs that impact policy development

            In healthcare, we must have policies to help guide nurses in their specific roles, rules, and regulations of their practice and fulfill a knowledge base for the everyday care of their patients (Annesley, 2019). Policies must be realistic and obtainable, or they will never survive the healthcare environment. When developing a policy, one must consider how it could affect the healthcare workers, patients, and resources, such as the healthcare entity being about to afford the necessities to coincide with the policy.

Nurses work daily with patients at the bedside and should be involved in policy development. They know their working environments and what resources are needed to do their job effectively and can usually anticipate patients’ needs. Part of nursing is knowing the needs of patients with various socioeconomic classes in different environments, being conscientious of ethics and what is right for patients and staff members, and providing the best care for patients (Walden University, LLC, 2012).

Competing needs that impact the nursing shortage and quality of care

            Nurses can agree that nursing shortages affect the quality of care that is provided to patients. They also can usually notice that if there were more resources for staffing, for example, it could lead to a better quality of care (Suhaimi et al., 2021). Resources, such as money, obviously play a large role in nurse staffing because they must be able to pay their staff and add more positions to care for the patient numbers they are serving. There must be an incentive to attract new nurses to the entity to fill open positions, and companies must be prepared for this. Money also plays a factor in caring for the patients and having the resources needed, such as equipment and medical supplies. Lastly, patients impact the nursing need because if a facility has been low census for some time, they will not keep the same number of nurses on duty at one time and may even let some of their staff go if they are no longer needed. There must be an anticipation of what the current patient population might need; for instance, if there are more needy, heavier care patients, the entity must be able to fulfill the needs of this by providing enough care to provide for those patients.

Impacts and how they are addressed

            The impacts of the nursing shortages are causing more stress on the current nurses, causing them to want to leave the profession, creating unsafe working environments, increased errors, and patient care quality problems. Many states have investigated ways to keep and recruit more nurses, lessening requirements for licenses, modifying laws relating to the nursing scope, and paying it forward to healthcare workers through incentives (Enlund, 2022).

The government also recognizes that the quality of care of patients is of utmost importance, and the way to do that is to provide better quality that will reduce errors.  The plan should also include the recruitment and retention of nurses in healthcare entities. The standard set for nurses is that they should only have one patient in a trauma situation in places such as an ER, one patient in surgery, up to two patients in units such as L & D, tele, peds, etc., up to three patients in units such as the ER, four patients in units such as psychiatry and med surg, for example, up to five patients in SNF units, and up to six patients in units such as post-partum (Congress.gov, 2021). As nurses, we all know this is not the case, more often than not. Facilities continue to push nurses to their max performance and expect the top-notch quality to be given to patients simultaneously. Where is the tipping point where these laws or followed by facilities, or else they are fined or held liable for not abiding by them?

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According to the American Nurses Association’s Code of Ethics for Nurses (2015), “The workplace must be a morally good environment to ensure ongoing safe, quality patient care and professional satisfaction for nurses and to minimize and address moral distress, strain, and dissonance” (Provision 6, p. 25). The national healthcare issue of medical, clinical, and auxiliary staff shortages in nursing homes and long-term care facilities undermines a healthy moral environment, safe practice for nurses, and quality care for residents. Kelly and Porr (2018) noted that “RNs are constantly challenged to provide quality nursing care, while resources are chipped away,” which exacerbates “frustration, exasperation, and a sense of powerlessness to change their circumstances” (Para. 2). Thus, nursing shortages, deepened by the COVID-19 pandemic, constantly compete with other needs, such as restricted budget, patient dissatisfaction, staff burnout, scarce resources, etc., and directly impact policy development on state and federal levels. According to Enlund (2022, June 20), states endorsed a variety of legislations to alleviate the nursing shortage, including “loosening licensing requirements, changing scope of practice laws, bolstering educational programs, and offering monetary incentives” (State Action section). Most states enacted licensure compact legislature “to allow various types of health professionals to provide services to patients in other states” as virtual healthcare gained more popularity during the pandemic (State Action section). Additionally, states expanded the scope of practice (SOP) for nurse practitioners (NPs), “waiving some types of practice agreement requirements to allow increased access to providers” (State Action section). On the federal level, multiple competing needs and, consequently, inadequate nursing homes performance during the peak of the pandemic prompted a complete policy revision impacting nursing homes and long-term care facilities operations. Thus, on March 1, 2022, the Biden administration revealed a comprehensive nursing home reform to ensure sufficient staffing and funds for safe and undisrupted nursing home functions. According to Edelman (2022, March 3), the reform enables “improving nurse staffing levels and holding facilities and their corporate owners accountable for the billions of dollars they receive under the Medicare and Medicaid programs” (para. 1). The reform provisions pursue such goals as to “establish a minimum nursing home staffing requirement, reduce resident room crowding, strengthen SNF value-based purchasing, reinforce safeguards against unnecessary medications and treatments” and other quality enhancing goals (para. 6).

Additionally, competing needs of the workforce can directly impact the national healthcare issue of the nursing shortage. As facilities are short in staff and desperately seeking solutions to temporarily fill in the gap in the schedule, travel nurses became increasingly popular to provide short-term relief. According to Enlund (2022, June 20), travel nurses are “employed by an independent nursing staffing agency instead of a single hospital,” travel across the country, and “provide temporary, immediate assistance to a hospital or other facility seeking short-term nurse staffing solutions” (Travel Nurses 101 section). According to American Hospital Association (2023, February 16), “data from a forthcoming Syntellis Performance Solutions/AHA report will show that travel nurse full time equivalents (FTEs) per patient day rose over 183.4% from 2019 to 2022” (p. 3). As demand for travel nurses continues to grow, the salary of travel nurses is “three to four times that of a full-time employed nurse” (Enlund, 2022 June 20, Travel Nurses 101 section). As a result, competing needs of the workforce create an imbalance in salaries and further strain healthcare facilities’ resources by operating in the circumstances of staff shortages and paying overcharged staffing agencies’ services. The states attempt to compensate for the impact of workforce competing needs on unfair pricing by applying “price-gouging law,” which prevents an “unconscionable” increase in pricing during emergency and resource scarcity situations (Enlund, 2022 June 20, Travel Nurses 101 section). For example, Minnesota and Illinois imposed limitations on staffing agencies’ pricing with a 150% wage cap “of the median wage rate over the preceding three years” (Enlund, 2022 June 20, Travel Nurses 101 section).

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Developing Organizational Policies and Practices

Competing Needs Impacting Nurse Staffing Issues Nurse staffing issues are prevalent in the healthcare industry and significantly impact patient care outcomes. Two competing needs that impact nurse staffing issues are staffing shortages and financial constraints. Staffing shortages occur when nurses cannot meet patient care demands, leading to higher workloads, job dissatisfaction, and nurse burnout. Financial constraints refer to the limited resources that healthcare organizations have to allocate to nurse staffing, which may result in inadequate staffing levels, compromised patient care, and staff burnout (Costa & Friese, 2022).

The relevant policy in our organization that influences nurse staffing is the staffing ratio policy. The policy stipulates the minimum number of nurses required to attend to a specific number of patients. For instance, the policy may require a one-to-four nurse-patient ratio for intensive care units. The policy is intended to ensure patient safety, adequate staffing levels, and optimal patient outcomes.

The staffing ratio policy in our organization has ethical implications that require critical examination. First, the policy may be compromised if healthcare organizations prioritize profits over patient safety. If a healthcare organization understaffs, patients may be at risk of receiving suboptimal care, leading to adverse outcomes, which is against the ethical principle of patient-centered care. Secondly, the staffing ratio policy may infringe on nurses’ autonomy and professionalism, leading to job dissatisfaction, turnover, and burnout. Nurses may feel overworked and undervalued, leading to ethical dilemmas regarding their professional responsibilities ( Abhicharttibutra et al., 2017 ).

To balance the competing needs of resources, workers, and patients and promote ethics, the following policy or practice changes can be implemented: Increase the use of technology to support nurse staffing: Our organization can implement innovative care models, such as remote monitoring and mobile apps, that can increase nurse productivity and reduce the demand for in-person care. This approach can address the staffing shortage issue and reduce the workload on nurses, leading to improved job satisfaction, reduced burnout, and better patient outcomes.

Another practice our organization can do is to Implement a flexible staffing policy. A flexible staffing policy can allow nurses to work flexible schedules that accommodate their personal needs and preferences. This approach can reduce nurse burnout, increase job satisfaction, and improve nurse retention, leading to better patient care outcomes.

Evidence supports the effectiveness of technology and flexible staffing policies in addressing nurse staffing issues. A study by Li et al. (2021) found that remote monitoring technologies, such as telehealth and mobile apps, significantly improved patient care outcomes and reduced the workload on nurses. Another study by Yin et al. (2019) found that implementing flexible staffing policies increased nurse satisfaction and reduced job burnout, improving patient care outcomes.

Competing needs, such as staffing shortages and financial constraints, can significantly impact nurse staffing issues in healthcare organizations. To address these challenges, healthcare organizations can implement policies and practices that balance the competing needs of resources, workers, and patients while promoting ethics. Technology and flexible staffing policies can improve nurse retention, job satisfaction, and patient care outcomes. It is essential to have evidence-based resources that support policy or practice recommendations to ensure optimal outcomes for patients, healthcare providers, and healthcare organizations.

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Competing needs refer to the various demands and pressures that healthcare organizations face, including those of patients, healthcare providers, and available resources. These competing needs can significantly impact the development of policies designed to address nurse staffing issues. For example, healthcare organizations may need to balance the need for adequate staffing levels to ensure quality, effective, and safe patient care while managing limited resources and financial constraints( Goldfarb et al., 2008 ).
Specific competing needs impacting nurse staffing issues may include staffing shortages, patient demand, and limited resources, including staffing and staff training funding ( Costa & Friese, 2022 ). For instance, nurse staffing ratios may be impacted by the need to manage patient demand for care, limited staff training and development resources, and staffing shortages due to increased patient acuity and nurse burnout.
Policies can address competing needs in nurse staffing by balancing the various demands and pressures of healthcare organizations, patients, and healthcare providers. Effective policies must consider the various stakeholders’ needs and prioritize their needs to ensure patient safety and optimal health outcomes ( Abhicharttibutra et al., 2017 ). For example, policies may include a balance of staffing ratios to manage patient care demands while maintaining safe staffing levels, providing incentives for staff training and development, and addressing nurse burnout through flexible scheduling and wellness programs.
In addition, policies could address the nurse shortage issue by promoting technology and innovative care models that can increase efficiency and reduce the demand for nursing staff. For example, mobile apps and remote monitoring technologies can help reduce the need for in-person care and increase the productivity of nurses.
In conclusion, competing needs are inherent in healthcare delivery and can significantly impact the development of policies designed to address nurse staffing issues. Effective policies must balance competing needs, prioritize patient safety and health outcomes, and consider the various stakeholders’ needs, including patients, healthcare providers, and available resources. Adequate nurse staffing

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Competing Needs Impacts on the Development of Policy

The development of policy is very complex. One must address an issue’s economic, social, and political variables. However, there are competing needs that can impact policy development. These needs include workforce, finances, competitors, or limited resources. These competing demands impact policy development by limiting or altering the resources required to develop the policy. However, these competing needs can positively impact the development of policy by forcing one to address these competing needs and form a stronger approach that will deliver more significant outcomes (Broome & Marshall, 2021; Kelly & Porr, 2018).

Competing Needs Impacts on Nursing Shortage Policy

The nursing shortages affect direct patient care, funding, and reimbursements to healthcare organizations and the general healthcare environment in America. Many competing needs impact the nursing shortage policy development. One competing need would be the nursing workload specifically related to nurse-to-patient ratios. Many states do not have mandatory regulations to limit high nurse-to-patient ratios, leading to high nurse-to-patient ratios and increasing nurse burnout. Nurse burnout leads to other competing needs of the workforce. With nurse burnout, one has nurses leaving the profession. This impacts the development of policy for the nursing shortage by limiting the available workforce. Finally, finances are a competing need that impacts policy development for the nursing shortage. Healthcare organizations must address the nursing shortage issue while improving patient care quality and minimizing or improving financial costs. Depending on the healthcare organization’s funding and reimbursements, along with their current financial status, this could hinder what the organization could offer finically for the policy (Broome & Marshall, 2021; Buerhaus, 2021; Jones & Spiva, 2023; Pittman & Scully-Russ, 2016).

Addressing Competing Needs

One may address the competing needs with the nursing shortage policy development by first setting mandatory regulations for safe nurse-to-patient ratios. This would help improve nursing workloads and decrease nursing burnout. Also, safe nurse-to-patient ratios can improve patient care by decreasing medication errors and infection rates associated with high nurse-to-patient ratios. Next, one must listen to the nurses who left the profession related to nurse burnout and make changes to bring the nurses back into the profession. This will not be a simple fix and will take altering America’s current healthcare as a whole. Finally, healthcare organizations must perform risk assessments to analyze what can be done financially to improve the nursing shortage. The development of the nursing shortage policy will be complex. However, it is vital for the healthcare system in America ( Buerhaus, 2021; Kelly & Porr, 2018; Jones & Spiva, 2023; Pittman & Scully-Russ, 2016).

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It is difficult now more than ever for hospitals to allocate resources, resources are becoming more costly and healthcare systems have budgets (Daniels, 2016). During the Covid-19 epidemic we faced a lot of shortages in supplies and resources and organizations had to allocate for that. I believe one of the deficient we have is a shortage of nurses. Due to this shortage, nurses are required to take on a larger workload and patient to nurse ratio. Policies must be development on limits to these ratios to ensure patient safety, the nurses well-being, and nurse retention. The purpose of this post is to discuss how competing needs and limited resources effect policies and how this effects high patient to nurse ratios.

           High patient to nurse ratios can decrease the survival rate for critically ill patients (Lee et al., 2017). When a nurse is assigned a workload with a high ratio, that gives the nurse less time to spend with each patient individually which can make it easy to miss errors or signs of impeding distress. Nurses carry many hats, and they need time to complete all of their tasks safely, to ensure a good patient outcome. Due to the current nursing shortage, organizations have to weigh their resources for care and one of these sacrifices is the patient to nurse ratio. But patient and nurse safety must be taken into consideration when determining how many patients a nurse can care for.

          Nurses are required to provide good quality care to their patients while working with limited resources (Kelly & Porr, 2018). Policies will address the competing needs by setting limits to patient to nurse ratios. While there are patients waiting to be cared for, this should not jeopardize the health of other patients due to unsafe workloads on nurses. There should be policies in place that put a limit on the number of patients a nurse can safely care for. There needs to be policies in place to no only increase patient safety and good outcomes, but also the safety and well-being of the nursing staff. Studies have shown that high workloads, low staffing rates, and long shifts can lead to nursing burnout (Dall’Ora et al., 2020).

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Organizational Policies and Practices to Support Healthcare Issues

Allocation of resources is something that nurse leaders can be involved in within the organization at which they work. Many resources are finite, and leaders need to weigh the pros and cons of when and where they are allocated. Nurse leaders have a responsibility to think of the greater good of all involved when making decisions like these. The purpose of this discussion assignment is to explain how competing needs impact the development of policy and then describe specific needs that impact the healthcare issue selected.

Competing Needs Impacting Policy

There are many different resources that organizations have that can be allocated to different needs. One need of the workforce is appropriate staffing. This is an important need as there are laws regarding nurse to patient ratios and when there are not enough nurses, patients may be turned away for care. Organizations do not wish to ever have to do this, so there are resources in place to ensure that appropriate staffing can be obtained. One resource is money. Extra funds may be in place in some organizations to be spent on travel or registry nurses. This being said, these extra funds can only go so far when used on a short-term or temporary fix such as using these nurses. Policies should be developed so that all of the allotted money is not used up on these quick fixes. Our book mentions that nurse leaders have the gift of influence and need to practice that quality cautiously (Broome & Marshall, 2021). Some organizations have policies in place to cap the wages of travel nurses. This creates a dilemma though, if wages are capped, will nurses be less inclined to sign travel contracts (Odom-Forren, 2022). The main issue is that these short-term contract nurses are making significantly more money than the regular staff nurses at an organization. This creates a strain between coworkers that can be carried into the workplace if not careful. Organizations have many different needs but since the pandemic, the issue of travel nurses and wages has become more talked about. There should be policies in place so that this scenario does not occur.

Specific Needs for Staffing Shortages

Nurses are required to continue to work through tough times when resources are allocated elsewhere, seemingly unfair (Kelly & Porr, 2018). I selected the national healthcare issue of appropriate staffing needs and nursing shortages. One condition that impacts this issue is the lack of funds to pay nurses fair wages. One short-term solution to the issue of staffing shortages is to utilize travel and registry nurses. The problem with this is that it is a short-term and very costly solution. These nurses are paid much higher wages than regular staff nurses and then after their contract, they are gone and the unit is once again short staffed. Organizations should be focused on other solutions that will last longer over time. Policies should be made to assist in this. One solution is to retain the staff nurses that are already working there. Most organizations do not give high or frequent increases in wages which is a big reason for high nurse turnover rates. If these organizations had access to use the resources of funds previously allocated for travel or registry nurses, they may be able to offer their regular staff a wage increase or just a bonus. This way, the funds are still being allocated to the short staffed unit but it acts as an incentive for the regular staff nurses to continue coming to work. This can be considered a gamble though and any use of money resources needs to be thoroughly thought through by nurse leaders.

Conclusion

In conclusion, resource allocation is seen in every nursing organization. Nurse leaders are responsible for determining what areas need what resources and when. As mentioned above, there are many different scenarios and needs depending on the time and place and what is appropriate for the organization at that time. Overall, it is essential for nurse leaders to be comfortable making these decisions for the greater good.

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The nursing shortage is a national healthcare issue. It has become a major stressor on the healthcare system. There is a myriad of causes for the problem, but most can agree that the shortage of nurses can lead to errors that put the patients at risk (Haddad et al., 2022). The stress caused by the shortages prompts some to take short cuts that affects the nurse’s effectiveness causing ethical dilemmas.

According to Milliken (2018), every interaction between a nurse and a patient has potential ethical impact.  It further suggests that many nurses are not aware that routine nursing tasks can have ethical repercussions. Nurses need to be taught to recognize and mitigate potential ethical dilemmas (Milliken, 2018).

Haddad et al. (2022) shows us that the aging population requires more nursing care. It also reports that approximately one-third of nursing professionals are over the age of 50 and are slated to retire in the next decade.  The shortage is compounded by a lack of faculty to teach new nurses, and organizations such as The National Academy of Medicine lobbying for a policy mandating that facilities have 80% of their nurses holding a Baccalaureate degree (Straka et al., 2019).With some organizations calling for even more advanced education in order to become a Nurse, the time needed to replace the retiring nurses is lengthened (Broome & Marshall, 2021).

Some of the competing needs that impact the issue of the nursing shortage are the fact that there is an immediate increased need for nurses due to the increased patient load caused by an aging population. There is also an urgent need to train healthcare professionals to replace the retiring nurses. One study suggests that using virtual reality can speed up and enhance training making training nurses faster and less expensive (Shorey & Ng, 2021). Policies that accept the use of new teaching technologies to teach certain skills would help alleviate the backlog on nurse education. Policies that would continue to accept ADN nurses would also reduce the educational investment needed to bring new staff onboard.

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Quality healthcare should be important to everyone in the healthcare profession for more than one reason: we have two jobs, one the care we provide and two improving the system in which we work. When implementing policy, it is often done with the intent to improve standards that are already in place or for standardized guidelines. According to Mozafaripour (2022), health policies are essential to establish guidelines that benefit the patient, the organization, and the healthcare system.  But should that be the only reason? One could argue that it is rather pointless not to incorporate or consider the needs of the staff who ensures the smooth operation of an organization’s daily operations; however, some see the employees as nothing more than a business relationship and taking the employees’ emotions, feelings, and suggestions into consideration is neither essential nor worthwhile.

While many may argue that nursing shortages existed before the pandemic, there is no doubt that the pandemic has amplified the number of nurses that have exited the profession.  After the pandemic, many nurses suffered from multiple mental health challenges, countless frustration, and immense reports of burnout. Amid all this, they were still expected to offer standardized quality care with unreasonable demands with limited resources. These unrealistic demands further frustrated nurses and gave them no choice but to leave the profession. It is one thing to be dealing with being abused physically, mentally, emotionally, and verbally, but having to deal with little or no resources, inadequate compensation, an increase in demand for quality care, and not having the proper infrastructures in place to do so further forced nurses to seek less demanding jobs roles.

As noted by Kelly and Porr (2018), the excessive workload is a severe issue because of its widespread nature and long-term effects on burnout and retirement from the field.

Organizations are trying everything to cut back on spending and, simultaneously, demand an improvement in the standard of service at the expense of the nurse’s mental health and well-being. In some organizations, the nurse is the phlebotomist, the clerk, the patient care technician, the janitor, etc., while still being required to offer efficient and quality services to patients. Practices of such should be halted, and the general population should be made aware so that new guidelines for safer practices can be implemented.

Without proper security for better, safer working conditions and improvement in resources, the improvement in quality services and patient care will be at further risk. Between our growing population, and people living longer due to the advancement in healthcare and technology being used to improve the quality of life for many, the demand for more nurses is in full effect; however, due to the unsafe nurse-to-patient ratio and the increasing abuse against nurses, many nurses are moving away from the bedside. In some hospitals, nurses are forced to care for up to 10 patients, increasing medication error, mortality rate, frustration, and burnout. In a Detroit hospital, nurses recently filed a wrongful termination lawsuit after they alerted state authorities of their concerns about poor nursing staffing conditions that led to unnecessary patient death (Galea & Galea, 2022). One of the roles and responsibilities of a nurse is ethically “to do no harm,” In doing no harm, it is also the nurse’s responsibility to advocate for the patient’s needs, especially when the patient’s life is endangered. Having to deal with these unsafe practices constantly has further frustrated nurses leading to rapid turnover and nurses moving away from a once-loved role. Healthcare leaders must enforce/implement regulations that will see nurses practicing safely to improve the outcome of patients.

Since the demand for care and treatment has grown significantly, the level of frustration by our patients and their families has also increased. With this increase, the attacks against nurses have also increased, and in places such as the ER, outpatient clinics, and medical-surgical units, the nurse-to-patient ratio is excessive. Healthcare administrators consistently strive to improve the quality of care for patients; however, not implementing policies and guidelines to maintain the safety of their staff will further see a depletion of nurses moving away from the bedside.

Costa and Friese (2022) recommend that the Centers for Medicare and Medicaid Services (CMS) adopt laws to promote safe nursing care and give nurses better working conditions, appropriate compensation, and benefits to enhance patient outcomes. They also recommended that Congress fund the creation of new, safer healthcare systems and expand the testing of safety measures and procedures to improve the well-being of healthcare workers. All nurses should champion these strategies to ensure that the preservation of the profession is continuously upheld to its highest standards and not dwindled down the drain at the expense of this cooperation to save money and ensure the lives of the people we commit to serving are not treated unsafely or endangered.

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Competing Needs Impacting Policy Development

The administration of a healthcare institution operates similarly to that of any other business, with the significant goals of maximizing profit, increasing patient outcomes, lessening maintenance expenses, and efficient resource use. When resources and the workforce are unavailable to satisfy these expectations that arise simultaneously and strive to be satisfied together might result in conflicting demands. As a result, there are conflicts between the distribution of resources and the setting of priorities by end users, such as nurses (Kelly & Porr, 2018). To attain the quadruple aim of patient satisfaction, affordable health care, population health, and healthcare worker satisfaction, it is morally, legally, and ethically necessary to deliver the finest patient care to all patients regardless of their background. The rising cost of healthcare, arguably due to the ongoing development of life-saving medication and healthcare technology, has made it more difficult for those who cannot afford healthcare costs to access high-quality care equally. Due to the conflicting needs of employers and employees, mistakes such as medication errors have increased, and nurses’ board licenses have been affected. The Affordable Care Act of 2010 and other healthcare laws have been implemented to eliminate the healthcare disparity brought on by the high cost of healthcare (KEN, 2022).

Competing Needs Impacting Selected National Healthcare Issue/Stressor

The National Health Council (NHC) is dedicated to encouraging the development of a society where everyone has fair access to high-quality medical care. The rising healthcare costs brought on by technical and medical innovation are one of the biggest obstacles to achieving health fairness. Health services for individuals and groups based on evidence-based professional knowledge are considered to provide quality treatment because they are more likely to result in desired health outcomes. Health services must be prompt, egalitarian, integrated, and efficient to have the desired effects of excellent healthcare (WHO, n.d.). According to the NHC (2021), dental treatment is the most common form of care individuals report delaying because of cost, with just half of US adults reporting being able to pay healthcare expenditures. Many facets of healthcare, including hearing treatments, dental work, and prescription medication expenditures, are reported to be challenging to pay for by sizable percentages of persons 65 and older. Adults without insurance, individuals of color, and people who fall below the poverty line are disproportionately impacted by healthcare expenditures. A third of persons with health insurance are concerned about paying their monthly premium, and 44% are concerned about meeting their deductible before their insurance begins to pay benefits (Montero et al., 2022). A significant portion of Americans is burdened by healthcare debt, with 41% of individuals reporting that they owe money for medical or dental expenses, including obligations to credit cards, collection agencies, family members, friends, banks, and other lenders (Montero et al., 2022). The number one concern for Americans today is how to pay for petrol and transportation expenses, which is followed by unforeseen medical expenses (NHC, 2021). Other barriers to accessing high-quality care include the inability of healthcare providers to exchange medical information due to a lack of interoperability, the staffing shortage caused by burnout, the need to hire and retain employees, and the requirement that clinicians receive training in the newest medical technology. Patient safety is crucial for the healthcare system, with increased hospital-acquired infections in 2020. These are competing needs that attract healthcare expenditures before they can be achieved. Also, healthcare inequalities the disadvantaged patient population encounters, such as racial and gender bias inequities, must be addressed (Wolters Kluwer, 2022).

The Impacts and Ways Policy Address Competing Needs

The impacts of these conflicting needs are evident when hospitals have an influx of patients in the ER with easily manageable conditions that have been exacerbated due to healthcare inaccessibility. Also, the poll shows a racial disparity where high quality is less accessible to Blacks and Hispanics, low-income earners, and underserved communities (Montero et al., 2022). The NHC Reducing HCC Initiative evaluates various suggestions for legislation to bring down healthcare prices. The NHC has recognized four major policy priority areas, and its Board of Directors, with input from its members, are reducing barriers to the development of generic and biosimilar products, expediting approval of specific generic applications, improving coverage and reimbursement requirements to expand patient access and promote value, and promoting meaningful transparency on price and cost-sharing. The NHC is dedicated to expanding access to long-term, reasonably priced, high-value care across its programs and policy initiatives. Any savings realized from reforming policies should be immediately invested in ways that would help patients and the systems that support them. Promoting value as defined by the patient must be the foundation of all initiatives to lower healthcare expenditures (NHC, 2021).

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Organizational Policies and Practices to Support Healthcare Issues

In theory, a problem or a need can easily be identified and addressed with a simple solution and implementation of a policy or procedure; however, it rarely if ever works this simply, especially in health care. Competing needs of patients such as safe care and of those involved in the decision-making process as well as resources available, including money and workforce, have varying influence on what issues are addressed and how. All these needs are important to consider to ensure organizational success overall as well as success of the policy or policy change. Parkhurst et al. (2021) discuss competing interests on a much larger scale and in regard to malaria, but makes great points about how formulating health policy is not only about evaluating the evidence of what needs (i.e., patient needs and care team needs) are to be met but that many factors need to be considered in this formulation including stakeholders, power dynamics and interests, and the context of the organization itself. The formulation of policy is therefore multifaceted and complex.

Competing Needs, Policy, and APRN Practice Authority

Regarding the issue of limited scope of practice for nurse practitioners (NPs) and other APRNs, competing needs need to be considered as well. State laws and regulations determine whether NPs and other advanced practice registered nurses (APRNs) have full, reduced, or restricted scope of practice; however, facilities and organizations can further restrict scope of practice even further with their own policies (Winter et al., 2021).  In addition to policy restrictions, additional barriers to APRN full practice include lack of resources, poor relations with administration and physicians, and the profession being misunderstood and unrecognized – these barriers can also be considerations for competing needs affecting policy (Schirle et al., 2020). For instance, if the stakeholders do not value nor fully understand the skillset of APRNs and lack the additional resources to promote full practice authority of APRNs within the parameters of the law when resources are already allocated to physicians, policy change in favor of full practice authority is less likely to happen. Also competing needs to be considered, patient safety is a concern for some in relation to allowing APRNs to have full, autonomous practice authority as well as the possibility of increased costs and health care system strain (American Medical Association, AMA, n.d.; Robeznieks, 2020). These competing needs can lead to further miscommunication regarding APRN professions, the value they can bring to healthcare in general and to each specific organization, and consequently negatively impact future efforts to expand APRN practice authority. To address these competing needs, policy can make steps to expand APRN practice authority but with parameters and detailed explanations of roles of each member of the healthcare team to sponsor understanding of their role. Regarding practice authority, like Assembly Bill AB 890 that promotes full practice authority of NPs in California and was signed into law in 2020, organizational policy can make supervisory requirements for NPs and other APRNs, leading to eligibility to qualify for more autonomous practice over time and with more experience (California Board of Registered Nursing, n.d.). These changes can help build APRN relations with other organizational team members, promote patient safety, justify the use of additional resources or the reallocation of resources, and exhibit that no additional strain on the organization will result but that APRNs can be positive health care team members.

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How Competing Need Impact Policy Development

Healthcare policies work within the healthcare system to shape and protect everyone and everything within the walls of the hospital. Healthcare policies address healthcare access, delivery of care, cost of care, and privacy and patients and healthcare employees. Policies within healthcare are essential as they assist with the placement of guidelines to benefit everyone within the healthcare system. Policies work to prevent error and poor communication when it comes to decisions of medicine. Examples of healthcare policies could include patient care, drugs, safety and security, and employee health (University of St. Augustine for Health Sciences, 2021). All of these compete for the need of policy development as they are all essential to a functional and safe space in healthcare.

Competing Needs that Impact the Nursing Shortage

As discussed last week, the nursing shortage is a big issue with many factors at hand. With the nursing shortage comes a lack of educators, an increased turnover rate, and unequal distribution of work. Most units are working understaffed and with high acuity patients. This causes nurses to feel unsafe in caring for patients and unsatisfied as they are doing the best they can, yet it is not enough. Nursing staff shortages lead to an increase in human errors, patient and nursing dissatisfaction, and higher mortality rates. This leads to nursing burnout, increased stress levels, and the health of the nurse is now being jeopardized (Haddad et al., 2022).

How can Policies Impact Competing Needs

Ensuring that the workload of nurses is adequate when caring for higher acuity patients will not only ensure that patient’s are safer and happier, but also assist with nursing burnout. As mentioned previously unsafe and high workloads lead to nursing job dissatisfaction and therefore nurses are more likely to leave. This increases nursing turnover and another nurse is gone. Implementing policy of patient staffing and patient acuity will assist in keeping nurses happy and patient’s safer. Adequate staffing levels can result in a decrease of mortality rates, shorter hospital stays, and improved patient and nursing outcomes (Zhavoronkov et al., 2022).

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Competing Needs Impacting Policy Development

Forming and implementing new policies in healthcare can be a lengthy and arduous process. When writing policies, we must ensure that we are doing so with ethical practice in mind. Additionally, we must also consider patient care, billing, and data security (Writing Policies and Procedures in Healthcare, 2020). Policy making in healthcare is an involved process that should not be taken lightly.

Competing Needs Impacting the Nursing Shortage

The slow trickle of nurses leaving the profession or retiring has quickly become a hemorrhage that has led to the nursing shortage. Nurses are leaving the bedside or leaving nursing all together. Burnout is a strong contributor to this loss of nurses (Yang & Mason, 2022). As stated in the required media for this week, nurses and nurse practitioners are having to work double shifts to cover the gaps left by the nursing shortage (Walden University, LLC. (Producer), 2009b). This can lead to and worsen burnout. One could say that a competing need impacting the nursing shortage is the nurse’s own well-being. However, we can combat this by providing resources to nurses who are struggling with burnout.

Policy to Address Needs

Facilities should provide nurses with support during trying times. This can be in the form of EAPs (Employee Assistance Programs) run through their insurance. There should be policies in place for nurses to understand how to access these programs. The promotion of self-care for nurses is crucial. As the saying goes, “you can’t pour from an empty cup.”

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Several variables contribute to the complex situation of the nursing shortage. These variables include low salaries, poor working conditions, an increasingly aging population, and a lack of nursing faculty to educate new nurses. Broome & Marshall 2021 discuss the nursing shortage and address that one of the biggest threats of having understaffed faculty is the inability to prepare new nurses in school. In 2014/15, 68,936 qualified students were turned away due to these shortages. Although increasing student enrollment will help in alleviating the shortage, other essential factors such as long-term nurse workforce growth and retention can be done by giving nurses access to a secure and encouraging work environment. Even if we fix the problem with increased faculty, we still need to retain these nurses with a better working environment.

There are several policies in place that primarily protect the health and well-being of our staff and patients. These policies are a set of rules and guidelines that help ensure that we are providing our patients with the best care possible. Unfortunately, these policies are not always followed when it comes to our staff. The development of policies regarding safe patient ratios and proper PPE hasn’t always been followed. When these policies aren’t being followed it may cause an ethical dilemma for nurses when providing the best care possible. In Walden University’s video about ethical, moral, and legal leadership, Terry Mahan Buttaro, FAANP states “The moral, legal and ethical implications of practice are all back to the value of providing the best patient care for the community and the individual patient. That is what being a healthcare provider is all about”. According to Milliken, 2018, “Ethical awareness involves recognizing the risk that nursing actions could fail to adhere to the goals of nursing, thereby violating an ethical principle”.

The nursing shortage is a global issue and will continue to be this way until several areas are improved. New policies regarding incentives and bonuses to help acquire and retain nursing faculty can help with this issue. Increasing faculty staff will help with the recruitment of new nurses, however, policymakers should have other considerations regarding pay and workforce environments. This can include tuition reimbursement, sign-on bonuses, and the ability to offer a proper work-life balance. Travel nursing has taken a lot of our core staff away due to the higher pay and more flexible schedule. Policy regarding safe patient ratios really needs to be enforced as well to help retain our nursing staff and prevent burnout.

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When developing a policy, various factors and needs must be considered, including workforce needs, resources, and patients. These competing needs can impact the development of a policy in several ways.

For example, the workforce’s needs, such as ensuring adequate staffing levels and maintaining a safe working environment, may conflict with the requirements of patients, such as providing timely and efficient care. If a policy is developed to reduce staffing costs, it might increase workload and stress for the remaining staff, negatively impacting patient care and outcomes (Jun et al., 2021).

As COVID-19 cases surged in the US, healthcare systems became overwhelmed, leading to hospital beds, medical supplies, and healthcare worker shortages. This created a difficult balance between allocating resources to COVID-19 patients and those with other health conditions. It also led to many nurses and healthcare workers facing burnout. In a study completed with over 50,000 nurses, “For nurses who had considered leaving their position (n = 676 122), 43.4% identified burnout as a reason that would contribute to their decision to leave their current job (Shah et al., 2021).” 

Not only were nurses overworked and understaffed, but travel contracts for nurses soared throughout the pandemic, and many nurses were often leaving their primary jobs to join traveling agencies to make more money. That then caused some hospitals to need more nurses regarding their staffing ratios. Nurses that were required to care for more patients than they could handle safely caused increased workload and stress, which led to many of them quitting their job in healthcare altogether.

 Adequate staffing levels are necessary to meet patient needs and prevent nursing burnout, but budget constraints may limit staffing levels (Bielickj et al., 2020). It is essential to recognize that policies may have unintended consequences and that ongoing evaluation and feedback from stakeholders are necessary to ensure policies remain effective and responsive to changing needs.

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Competing needs within the healthcare system happen on a daily basis. When we look at competing needs and how they may impact the development of new policies, we need to remember that balancing healthcare issues and the competing needs is an act that leaders and management cannot take lightly. Some competing needs within the healthcare setting are budgeting restraints, aging work field nurses, nurse to patient ratios and the common shortage of nurses. When healthcare facilities create new policies such as those surrounding ethics, the healthcare issue of nursing shortages and burnout come up and can cause issues with fully practicing by that new policy. The code of ethics plays a huge role in healthcare and nursing. When there is an increase in nursing shortages such as recently due to Covid-19, ethics become an issue. According to Kelly & Porr (2018), nurses have become accustomed to not speaking up when they have been told what or how to do something that they know is unethical because of possible policies and or working short staffed. When nurses or providers cut corners to get things done because they are short staffed or facilities tell them to do these things, they are put in ethical situations that can cause an increase in burnout. Milliken, (2018) referenced the same and that often times providers and nurses are prepared due to training, education or management to deal with ethical considerations and this can increase the risk of burnout and create more moral distress.

One way that healthcare facilities can help with the issues such as staff burnout and shortages is creating a policy that designates a nurse to patient ratio. While most facilities state they have ratios, these ratios are not always upheld due to staffing issues. By implementing a policy stating for instance one Registered Nurse may not have more than 5 patients per shift with the following stipulations of acuity of the patient, if there are special needs for the patient such a sitter or devices in which aid the patient with ADL’s. When the acuity of the patient is higher, having a load of 5 patients still places the patient and the staff at risk for injury, burnout, ethical dilemmas.  Congress introduced the bill S.1567 in 2021 which is the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act. This bill states that hospitals must create and submit to the Department of Health and Human Services a minimum nurse to patient ratio. This bill was introduced to help nurses maintain safe and adequate patient staff ratios. In this bill, nurses may refuse the assignment if it is above the minimum ratio. Congress (2021). This type of bill I feel is a must and while staffing is an issue, staffing may get better when nurses hear about specific policies and or bills such as staff to patient ratios. The decrease in burnout, moral distress and unethical decision making will happen because staff are finally being heard.

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The physician shortage issue affects the workplace and is also a national problem. A report by the Association of American Medical Colleges highlighted a need for approximately 122,000 physicians by 2032 in the United States (Ahmed & Carmody, 2020). An organization’s policy must address the issue and guarantee quality and safe patient care. However, the organization’s resources must meet all the needs to ensure smooth operation and realization of distinct patient needs. Currently, healthcare facilities in the United States are pressured to simultaneously lower expenses and maintain quality outcomes (Akinleye et al., 2019). Therefore, various organizational needs are competing for financial resources. This discussion post outlines the competing need for drug availability and its effect on developing an organizational policy addressing physician shortage. Furthermore, the post will identify the impacts and how the policy may address the competing needs with examples.

There are various needs in the healthcare organization competing for the available financial resources. The issue of physician policy requires an organizational policy that will ensure the recruitment of an adequate workforce. Such a policy needs funding, leading to increased organizational costs (Terregino et al., 2021). The process of ensuring adequate physicians entails recruitment, training, and retaining. A new physician’s onboarding and recruitment fee is approximated at $500 000 and above annually (Terregino et al., 2021). From this perspective, the organizational policy will compete with other necessities, such as the availability of enough healthcare provisions, such as drugs. The healthcare organization must ensure that sufficient prescription drugs are in stock to enhance patient care. The facility requires much money to buy prescription medicines sold at a high price because of limited competition in the drug market (Vincent Rajkumar, 2020). At this point, the evidence confirms that drugs are a competing need for an organizational policy requiring the hiring of adequate physicians.

The purchase of drugs is vital to successful patient care. However, the high cost of prescription drugs and the need for more physicians increase the demand for financial resources. A lack of adequate funds increases the risk of compromised patient care (Kelly & Porr, 2018). A shortage of prescription drugs raises safety and patient care issues. Therefore, the healthcare organization must prioritize its procurement. On the other hand, hiring an adequate physician staff is a prerequisite. At this juncture, the healthcare organization needs a policy directing the distribution of resources to ensure all the competing needs are met to promote efficiency and quality of care. For instance, the organization may adopt a financing policy establishing the funds available for physician recruitment and prescription medicine (Tikkanen et al., 2020). Identifying money allocated for each need will reduce competition and ensure the healthcare organization has enough medicine and physicians. The physician shortage problem can be solved through an organizational policy advocating recruiting more healthcare professionals.

Healthcare organizations need to pay more attention to the problem of physician shortage. Developing an effective organizational policy depends on finding a balance between competing needs. From this discussion, it can be established that a financing policy has the potential to eliminate unnecessary competition for funding for drugs and the hiring of more physicians, and ensure all services are available to patients.

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How competing needs may impact the development of a policy

In the nursing arena it appears that there are frequent times of loss of focus being on the patient, their care, and why the staff and medical facility exist and their role of the care of the patient population.   When policies are being addressed, the financial cost aspect is oftentimes the driving force behind the development of policies.  Healthcare organizations look deeply into ways to minimalize financial cost and burden, while assuring an adequate nurse staffing ratio is met. Finding the means to balance both the needs of the patient and the nurse alike has a direct impact on national healthcare issues and policy development (Patricio, 2020).

Failed policy leads directly to shortages or overages of nursing and clinical staff.  These failures not only have a fiscal effect, but the failures also have a direct impact on quality and quantity of patient care.

Specific competing needs that may impact workload

Specific competing needs that largely impact workload are the needs of both nurses and patient populations. These needs are on the forefront of national healthcare issues.  Healthcare facilities and organizations frequently seek out change and look at exploring creative ways of balancing staffing and patient ratio needs.

Again, the balance that all organizations are seeking to rectify is the balance between quality care in a safe care environment and employing qualify nursing staff that all associated costs with these servic3s are the most cost effective (Holland, 2019). Equal distribution of workload and manageability of the workload requires a balance between patient needs and nursing staff ratios.

 

The impacts and how policy might address these competing needs

Burnout levels are on the rise here in the U.S. and many career nurses are leaving the field for good.  These past three years in particular have been very taxing and difficult on nurses across the globe.  While many policies and procedures were brought into existence during the COVID-19 pandemic, they were simply not able to compete with the patient care crisis.

Overworked nursing staff during the pandemic, fueled by lack of policy in place to cover such a medical crisis, assisted by the daily changing needs of the COVID positive patient population, led directly to high rates of job dissatisfaction, burnout, and widespread errors. Post Covid, there have been many changes in policy in an attempt to be more prepared should another pandemic like COVID arise unexpectedly in the future.  While these policies look at the future ahead, they cannot make up for what has happened due to the fallout of COVID.

Nursing ratios must be kept in a strict guideline format and policy needs to reflect the ratio guidelines.

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How Completing Needs Impact Policy Development

Competing needs are an inherent part of the policy development process, and they can significantly impact the development of healthcare policies. These competing needs can include the needs of the workforce, resources, and patients. The workforce’s needs are significant and can impact policy development as healthcare professionals require adequate resources, support, and incentives to provide high-quality patient care (Kelly & Porr, 2018). If healthcare policies fail to address the workforce’s needs, it can result in healthcare providers being overworked, stressed, and underpaid, leading to burnout and a shortage of healthcare providers. Therefore, policymakers must consider the workforce’s needs when developing healthcare policies.

The availability of resources, such as funding, technology, and infrastructure, is another critical factor impacting policy development. Healthcare policies need to be developed in a way that ensures that there is an equitable distribution of resources across different healthcare facilities and regions (Kelly & Porr, 2018). Policies that fail to consider the needs of resources can result in healthcare disparities, with some communities being underserved and lacking access to essential healthcare services.

Finally, the needs of patients are also a critical consideration when developing healthcare policies. Policies must ensure patients receive high-quality, safe, and affordable healthcare services. Policies should also address issues like access to healthcare services, patient rights, and privacy. Healthcare policies that do not prioritize the needs of patients can result in poor health outcomes, patient dissatisfaction, and increased healthcare costs.

 

Competing Needs that impact Access to Healthcare for Low-Income Population

Access to healthcare is a fundamental human right, yet it still needs to be discovered for many low-income populations. Several competing needs can significantly impact access to care for this vulnerable group. First and foremost, the needs of the healthcare workforce can create a shortage of healthcare providers in low-income areas. Low-income communities may need more providers as healthcare providers may prefer to work in higher-income areas with better resources and higher salaries (Khullar & Chokshi, 2018). Additionally, the need for help, such as funding and technology, can impact access to care for low-income populations. Limited financing for healthcare facilities in low-income areas can result in a lack of resources, outdated technology, and limited infrastructure, all of which can affect access to care.

Furthermore, the needs of patients can also impact access to care for low-income populations. Many low-income individuals face multiple barriers to care, including lack of transportation, limited availability of appointments, and inability to pay for necessary treatments. Policies that do not prioritize the needs of low-income patients can result in healthcare disparities and further limit access to care.

Competing needs can significantly impact access to care for low-income populations. Policymakers need to consider the needs of the healthcare workforce, resources, and patients when developing policies to address this issue. Failure to do so can lead to unintended consequences, such as increased healthcare disparities and limited access to care (Khullar & Chokshi, 2018). Policymakers must prioritize equitable access to care for all populations, regardless of socioeconomic status.

 

How can Policies Impact Competing Needs

Policies can have a significant impact on competing needs to access for low-income populations. Policies that prioritize equitable access to resources and services can help to reduce barriers and ensure that low-income populations have access to the resources they need. For example, policies that provide funding for affordable housing can help to address the competing needs of low-income populations by making housing more affordable and accessible (Kreuter et al., 2020). Similarly, policies that provide access to healthcare, education, and job training can help to address competing needs by providing resources and support to individuals who may otherwise struggle to access these services.

On the other hand, policies that prioritize the interests of wealthy individuals and corporations may exacerbate competing needs for low-income populations. For example, policies that prioritize tax cuts for the wealthy may reduce funding for social programs and public services, making it more difficult for low-income populations to access the resources they need (Kreuter et al., 2020).

Overall, policies that prioritize equitable access to resources and services are more likely to have a positive impact on competing needs for low-income populations, while policies that prioritize the interests of the wealthy may exacerbate these needs.

 

ConclusionTop of Form

In summary, policymakers need to carefully consider the needs of the workforce, resources, and patients when developing healthcare policies to promote equitable access to healthcare services. Failure to address any of these needs can have unintended consequences such as healthcare disparities, shortage of healthcare providers, and poor health outcomes. Policies that prioritize equitable access to care can help reduce these disparities and improve health outcomes for all populations, regardless of their socioeconomic status. Therefore, policymakers must balance the competing needs and develop policies that can address them to promote equitable access to healthcare services.

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How Competing Needs Impact Development Policy

The aging of the baby boomer population has increased the demand for nurses in healthcare.  We also have the impact of COVID-19 on top of the demand.  Often, I read that nurses make up the largest population of the healthcare industry, yet there seems to be a problem retaining nurses (AACN, 2022).  Nursing schools are still in business and turning out new graduates continuously, but little focus is put towards keeping the new nurses employed or even in the field at all.   Policies are usually driven by a need therefore it is reasonable to say competing needs of healthcare do lead to policy development,

Competing Needs Impacting Nurse Retention

Nurses are faced with the strain of being forced to follow the business model of healthcare when we were taught to follow the treat-heal-care model in nursing school (Kelly & Porr, 2018).  The stress of trying to care for our patients in a holistic, patient-centered manor along with trying to follow the business centered policy is causing nurses to have inward resentment that causing nurses to strike out towards other coworkers and patients.  This hostility creates a negative work environment causing a problem with nursing retention organization-wide as well as profession-wide.  Pay is another competing need that is impacting nurse retention.  Nurses are finding themselves working alongside other nurses who are from a travel agency making more than double their wages.  Again, this is leading to a negative work environment as well as a negative attitude towards the nursing profession all together.  Unfortunately, the world is always going to have sickness and need for healthcare providers, that need isn’t going to change.  The focus now is how do we address the needs and develop policies to address the competing needs that seem to influence nurse retention rates.

How Policy Might Address Nurse Retention

The Nurse Practice Act (Provision 6), talks about the work environment and how nurses have an obligation to create a good work environment and how work environmental factors can lead to ethical and professional fulfillment or it can hinder ethical and professional environment (ANA, 2015).  In regards to nurses facing the strain from trying to follow the business model of the organization and their desire to provide patient-centered care, executive nursing staff has the ability to create a more positive work environment by including nurses in decision policy decisions.  Develop committees from each department within the organization and have meetings to discuss concerns and try to reach compromise that will not financially harm the organization and still allow nurses to put patient care first.  In terms of nurses harboring resentment towards outside agency staff, nursing executives can implement a policy stating before utilizing outside sources, the shifts should be offered to organization staff nurses at an incentive pay.  This will cut down on hostility towards each other and promote a better work environment.  There is no way to ever create an environment pleasing to all but it is our duty to try to be fair and reasonable.   As nurses we must remember how it feels to work short and how we need nurses, therefore, we should try to make all efforts to work together not against one another.   After all, our Nurse practice Act states “the workplace must be a morally good environment to ensure ongoing safe, quality patient care and professional satisfaction for nurses and to minimize and address moral distress, strain, and dissonance” (ANA, 2015).  This is a must if the profession wants to retain nurses.

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Competing needs can be a huge stressor in the workforce. To be able to provide the best care for patient’s proper resources are a necessity. The healthcare issue/stressor that I picked was that of the opioid epidemic and overdoses that occur due to opiate dependency. Resources that would be needed for this subject would be proper educational material for patient’s and providers that help address signs and symptoms of dependency, which can hopefully lead to a decrease in overdoses and addiction rates. Education on different forms of pain management that steer away from opioids.” The National Institute on Drug Abuse (NIDA) has developed tools, as part of its NIDAMED initiative, to educate health care professionals about how to identify and treat patients with opioid use disorders. The materials include continuing medical education (CME), screening and assessment tools, and opioid prescribing resources” (“Improving opioid prescribing,” 2022). By providing these educational materials and additional resources providers and patients can look at different avenues for pain management, become more aware of when opioid dependency is starting to occur and can address what pain levels require opiates and which would be better managed with other medications. The issue with making a policy regarding this topic would be determining how you can label pain in a universal manner in which all patients can benefit from the policy being made. We never want to under treat pain and we want to make sure that the medication being given is appropriate for the type of pain a patient is feeling. Pain tends to be a person dependent which can make it more difficult to create a policy that would apply to all patients. The competing needs can be difficult for many reasons but lack of resources would be the main factor. The facility you work for may not have the budget or ability to allow for extra staff to provide these resources. Which can lead to patient’s falling through the cracks and being provided opiates to address pain when something else may be better suited for the patient. If a policy is created showing that additional resources are needed for the overall benefit and better outcome for the patient, additional funds may be allocated, allowing for safer medication practices.

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Healthcare is an evolving field. Aging workforces and populations, technological advances, growing demands for care, and regulatory constraints are all barriers to adequate treatment being provided (McNally 2018). Providing high quality healthcare is influenced majorly by the workforce so policies and procedures in place are key to delivering efficient healthcare, rather than attempting to make policies in crisis situations (McNally 2018).

When psychiatric nurses are exposed to workplace violence repeatedly with inadequate debriefing and follow-up, nurses can experience PTSD, burnout, turnover, decreased quality of care, and higher nurse-patient ratios related to short staffing (Dean et al. 2021).

Healthcare has accepted that there is a risk for violence in the workplace, especially working with high-risk populations, but that doesn’t mean it should be expected. A zero-tolerance policy should be in place, meaning that administrators will react to any complaints of verbal, physical, and sexual abuse promptly (Emergency Nurses Association). Although a zero-tolerance policy can’t stop every threat, special training should be offered to staff on how to handle aggressive situations, crisis teams should be present at facilities to immediately intervene in dangerous situations, and facilities should be inspected frequently to minimize risk factors of violence (Emergency Nurses Association). Evidence-based practice is the best way to implement policies to help avoid situations from arising.

Nursing Retention

In the field of nursing we often face heavy workloads, mentally exhausting, physically exhausting, long hours, high stress,  and working short staffed on a frequent basis.  Now add a national pandemic to intensify the highly stressful occupation in the last 3 years and one can see how nursing retention is an even bigger problem.  Nursing retention focuses on preventing turnover and keeping nurses in the field (Tang & Hudson, 2019).  Nursing burnout and shortage are two of the biggest factors that lead to nursing retention problems.  One factor to be considered in retaining nurses is that the profession and organizational leaders place emphasis on employee well-being.  Employee well-being can be broken down in five areas: Purpose, financial, social, physical, and community well-being (Jacobs et al., 2018).  I’ve recently started a new job working for the federal government at a VA hospital, this has been a big change from the private sector hospital I worked at for 16 years.  The private sector hospital faced major issues with nurse retention.  Nurses who had worked there for years such as myself were leaving due to working stressful jobs with inadequate staffing, poor benefits, lower pay than other hospitals or healthcare sectors, and generally not feeling valued.  Now, I’m working in a federal employment sector where the pay is the well above average, benefits are superb, respect for staff is required, workload is divided fairly in a manor relevant to your level of education, and you are paid based on your years of experience.  With all of those perks to working a federal job, there is still a big problem with nurse retention at the VA.

Social Determinants

One common social determinant that leads to nurses wanting to leave the profession is the mental and physical strain on a nurse.  COVID-19 increased the physical and mental demand of the nursing profession.  In an article written by Butler & Johnson (2020), four social determinants were narrowed down to: Family concerns (childcare, moving, non-job illness, and others); Economic (pay and benefits); Stress (job stress, job illness, other job dissatisfaction, nurse job dissatisfaction, and lay-off concerns); and Other (travel, another occupation, and school).  After COVID hit in early 2020, all of these social determinants were even more affected and caused an even higher rate of nursing job turnover and a mass exodus in the nursing profession.  A survey released by Elsevier in 2022 reveals a prediction that 75% of healthcare workers will leave the healthcare profession by 2025 (Bruisie, 2022).  Nurses make up the biggest population of healthcare workers so if this prediction comes true, healthcare will be in for another transformation and crisis.

My Workplace Retention Strategies

The VA has done some restructuring to improve nurse retention.  The organization has adapted to the Theory of Complex Adaptive Systems which recognizes the need for an organization to adapt to change which leads to new and creative solutions to problems within the system (Broome & Marshall, 2021).  The VA recently owned up to the fact that they were one of the lowest paying organizations in healthcare, nurses received a huge raise in salary as high as 24%.  Registered nurses are given an $8000 sign on bonus to be distributed in 4 payments over a year.  After 1 year of employment, the VA offers the Education Debt Reduction Program (EDRP) which pays up to $200,000 of  student loans.  The benefits such as medical, dental, and vision insurances are offered at great rates and provide excellent coverage with a variety of choices.  Retirement is one of the best on the market matching 5% of employee contribution and paying $.50 on the dollar after 5%.  Paid time for 13 federal holidays as well as earning 12 hours of leave time every 2 weeks.  Last but not least,  nurses get 5 weeks of paid vacation from the start of their career at the VA.  Just to show how good this is to me, my former employer I gave 16 years of my career to matched 3% max on retirement, after 16 years working I was up to 4 weeks vacation I had to pay for using my PTO which I also had to use to cover sick time and days we were closed for holidays.  Progress is being maJade but the VA along with all other healthcare sectors have a long way to go and must stay current with benefit and pay incentives to improve nurse retention rates.  Along with pay and benefits, employee well-being must be given high regard as well to promote a healthy work environment.

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One huge healthcare issue that we are all facing today is nursing burnout and shortages. There has been an increase in registered nurses and advanced practice nurses over the years due to the aging population and need for healthcare however, due to the increase in demand for healthcare, this can cause turnover and burnout in the healthcare providers (Broome & Marshall, 2021). One study has shown that physicians and nurse practitioners working together to meet the increased demand of patient care is aimed at preventing burnout  and improving access to and quality of care (Norful, de Jacq, & Carlino, 2018). The supply of physicians over the years has decreased which has not helped the demand of healthcare services needed. The longer medical education needed for physicians contributes to the shorter supply which is where advanced practice nurses can alleviate this constraint since their training is shorter (Auerbach, Staiger, & Buerhaus, 2018).

The shortages and staff burnout has caused many issues within healthcare. Just in the emergency department that I work for, the shortage of nurses we experience is causing us work fatigue and burnout. This has a direct impact on nurse retention. Nurses are leaving the high stress setting of the emergency department to work for a lower stress job. There are times I am taking care of intensive care patients plus emergency care, such as cardiac arrests. This causes nurses to question the care they provide and if is high quality because of the needs of these patients. It also makes them question if their license is at risk.

Social determinants of health such as underserved areas is impacted by the shortage of nurses and providers. A culturally diverse nursing staff can help with more competent care of minorities. However, this cannot be accomplished if there is a shortage of staff. We currently have four nurses on staff in the community emergency department that I work for who are Spanish. The Spanish population in this particular area is high so it is important to have staff that know the culture and language for better patient care. Patients with this ethnic background would be more trusting of healthcare staff that have this culture knowledge and experience (Broome & Marshall, 2021).

The healthcare system I work for is attempting to respond to the shortage to end nursing burnout and turnover. They have hired a nursing recruitment agency that is offering sign-on bonuses in order to attract more nurses. They also have offered overtime bonuses to help with the day-to-day operations and have travel nurses working as well. When it comes to the shortage of providers like physicians and advanced practice nurses, they have been using locum tenens (temporary providers) and float providers within the healthcare system. The float providers bounce from hospital to hospital within the healthcare system. Although there are a couple ways they are trying to assist with the shortage to avoid burnout in staff, it seems these measures aren’t really helping. Some staff work the overtime to help however, we are still losing nurses because they are tired and want a lower stress job.

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Lack of Mental Health Resources

Lack of access to mental health resources is a problem that is getting worse. The Covid-19 pandemic put a significant strain on an already strained healthcare system, making providers and organizations do more with less, some even having to close their doors permanently. In April 2020, of the surveyed community mental health facilities, two-thirds stated that due to the current financial climate, they believed they could only keep operating for a maximum of three months (Majlessi, 2020). Organizations had to make significant staff cuts, decreasing their revenue while trying to curtail overhead costs. While it did help decrease the costs associated with daily operations, it also decreased the organization’s capability to service more patients and therefore bring in more income.

The pandemic did bring some innovation to providing healthcare for the medical community. Telehealth was more widely accessible, allowing for expanded services in rural and urban areas. Currently, 150 million Americans live in a federally designated mental health provider shortage area (Weiner, 2022). This problem has been a persistent issue even before the pandemic. Telehealth services can cover these areas, but that is not always an accessible or appropriate solution for all patients.

In Iowa, a state ranked dead last in the country in access to mental health, only two beds are available for every 100,000 people (Carpenter, 2023). This creates backlogs in ER and outlying facilities holding patients waiting for an inpatient bed. Access is impacted by social determinants of race, ability to pay, insurance, and location.

Workplace Response

The unit I currently work in came about as a response to many mental health patients waiting in the Emergency Room (ER) for days, waiting for a bed. This decreased our ER’s ability to see and treat patients as rooms were full of holding patients. As a result, one of our nurse leaders created a crisis observation unit to hold medically cleared psychiatric patients awaiting an inpatient bed. This unit is for adults only, with the possibility of opening a pediatric hold unit. This unit is staffed by psychiatric nurses that can adequately meet these patients’ needs. It also provides the patients more freedom- they have their own room and bathroom, and have access to a common room and complimentary therapy, if desired, rather than waiting in one room for however long it takes to find placement for them. Our psychiatric providers oversee these patients and coordinate care with outside facilities. We have a liaison on-site during the week from a local inpatient hospital to assist with placement in their facility and a telehealth service over the weekend that assists with placement. This unit is open to five beds currently, with plans to expand to twelve beds.

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Nurse Practitioner Autonomy

One major healthcare issue we are facing today is a provider shortage. With an ever-aging population, many estimates show that in order to meet the demand for primary care providers there will need to be an additional 52,00 primary care physicians by 2025 (Poghosyan et al., 2018). Primary care provider shortages have caused many states to remove the need for practice agreements between NPs and physicians.  One such state is NY after passing the Nurse Practitioner Modernization Act which would enable NPs to practice without written agreements after 3,600 hours of experience (Poghosyan et al., 2018). Getting society, organizations, and physicians to realize that NPs can be valuable independent providers, especially in primary care, is a national healthcare issue. Likewise, another possible model to decrease strain on primary care is the co-management of patients between NPs and physicians (Norful et al., 2018).  One study showed that this model can alleviate burnout, improve patient quality, and decrease individual workload (Norful et al., 2018).

Current Workplace

            Currently, I work in a correctional setting that hires FNPs, Adult NPs, and PAs as mid-level providers.  Working in a correctional setting we are constantly short-staffed in the medical department including providers and nurses. In my place of work, mid-level providers can treat and provide autonomous care however require a physician to cosign on some prescriptions such as opiates and some psychiatric medications.  Nurse practitioners can also perform simple bedside procedures such as I&Ds, suturing, stapling, and toenail removals.  Recently, the agency I work for also started to hire PMHNPs at medical centers due to the psychiatric provider shortage.  In order to attempt to recruit and retain more providers, the agency I work for has also offered generous 25% recruitment and retention bonuses along with paid moves. While there is room for improvement, the agency I work for has gone through great strides to improve mid-level provider autonomy.

Conclusion

            A study was performed at the VA comparing patient outcomes between patients assigned to an NP versus M.D. in various clinical settings (Liu et al., 2020). The study found that patients assigned to NPs were less likely to use primary care and specialty care services and incurred fewer hospitalizations (Liu et al., 2020).  Likewise, the clinical outcomes, diagnostic workups, and costs were not a significant difference between NPs and MDs (Liu et al., 2020). This shows that NPs can and should be trusted to provide patient care independently since they provide the same or better outcomes compared to MDs in some circumstances.  While some states have allowed NPs to practice autonomously, others still require physician collaboration which puts unnecessary strain on an already strained healthcare system.

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Workplace violence can occur physically, sexually, mentally, and through neglect. Violence can include beatings, shootings, rapes, threats, intimidation, harassment, and being cursed at/shouted at (Baker and Alshdefat 2020). Although workplace violence in healthcare is a largely arising issue, nurses working in psychiatric facilities are 20 times more likely to be assaulted than any other field (Baker and Alshdefat 2020). It’s reported that approximately 68/1000 psychiatric nurses are assaulted by patients whereas approximately 21/1000 nurses in other fields report workplace violence (Baker and Alshdefat 2020).

Long term complications of being a victim of workplace violence includes anxiety, post-traumatic stress disorder (PTSD), decreased productivity, increased burnout, death, and fear of returning to career but the continuous exposure to violence tends to lead nurses to feel that it’s just an accepted part of their job (Baker and Alshdefat 2020). Short staffing, lack of security, inadequate training, and uncoordinated treatment interventions play a huge role in increasing the risk of workplace violence occurring (Baker and Alshdefat 2020).

Social determinates of workplace violence include patients suffering with untreated mental health disorders, active substance abuse issues, inability to cope with situational crises, access to weapons (such a scissors or metal cans), and their own PTSD from history of violence. Worker risk factors include age, years of experience, gender (women are most likely affected), and absence of training in violent situations (Gillespie et al.).

A couple of months ago I left my job of nearly 3 years at a psychiatric hospital. I loved my job and what I did but the lack of support from management and lack of training for new hires was being physically dangerous. Within a one-year span I was held at gunpoint in the parking lot, spit on, punched, had a printer and desk chair thrown at me, almost received stitches from being hit and scratched, and was kicked in the face due to a new employee not being educated on proper hold techniques. Our facility had no security and an outdated security camera system that never worked, and they had no intentions on changing any of the flaws. During our handle with care training for new hires to learn how to safely do holds, seclusion, and restraints since covid the training was verbal and not hands on. It’s important to understand the steps of things you’re doing to prevent injury to staff and patients before a situation arises.

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One of the most in-demand professions nowadays is registered nursing. They offer care in every area associated with health care, including hospitals, doctor’s offices, outpatient care facilities, skilled nursing facilities, behavioral health settings, the home, schools, universities, jails, and workplaces owned and operated by private parties. In addition to being essential patient care providers, nurses play a significant part in addressing health outcomes disparities and enhancing the general well-being of the population (Zhavoronkova et al., 2022).

Nurses have started leaving the healthcare setting in droves, especially since the increased demands placed on them during the pandemic. Nurses have to take on increased patient loads which can adversely affect the rest of the patients they are caring for. These high staffing ratios are a surefire prescription for failure, as anyone who has worked at the bedside can attest. If nurses are given too many patients, they cannot give the best care. Some patients might not get all the required components of evidence-based care, and some requirements might need to be met. It is a system failure, not the nurse’s responsibility that this circumstance exists (Bourgault, 2022).

Some of the social determinants affecting our nursing shortage and burn out are the aging nursing workforce population, increased health demands due to an older population requiring increased care, higher hospital censuses, and greater acuity of the patients. Another major factor is the lack of nursing students that are graduating. Several nursing programs in the United States struggle to build facilities to accommodate qualified nursing candidates. Over 90,000 suitable undergraduate and graduate nursing students were turned away from schools in 2021, according to the AACN’s report 2021-2022 Enrollment and Graduations in Bachelor and Graduate Programs in Nursing. These rejections were due to a need for clinical education sites, classroom space restrictions, and staff (Tamata & Mohammadnezhad, 2022).

Academic Progression in Nursing supported initiatives on two fronts: initiatives that remove barriers that prevent nursing students from earning their BSN, such as support for collaborations between universities and community colleges to enable smooth progression from the associate’s degree (AD) to the baccalaureate; and employment-focused collaborations between schools and healthcare facilities that give students practical experience, encourage greater use of the BSN and create employment opportunities (Gerardi et al., 2018, p. 43).

I currently work in Hospice. We do not have a standard patient-to-nurse ratio. As a whole corporation, they have seen the increased demands on nursing staff and have allotted more nurses to be hired. However, appropriate candidates are hard to find, and few apply. A way our main branch is handling the nursing shortage that we are going through right now is that our director of operations has started to assist with patient admissions and on-call schedules. Our office is working together and being transparent about our difficulties and burnout. This was discussed in Pittman’s article. It was noted how important this was to establish this change (Pittman & Scully-Russ, 2016). Our director of operations is a great leader and checks with the staff daily to see how she can help.

Another significant concern that our director has noticed is taking on new patients that it would take longer than an hour for a nurse to get to. She is looking at how far the patient lives from our main office, and if it is not feasible to provide the proper care to the patient, we send that patient to a different hospice company and ensure they can provide the adequate care required for this patient. Our director is putting her staff first and not the financial bottom line.

In conclusion, the nursing shortage is not a new issue. However, it is now more pronounced as nurses put boundaries into place and expect more from their employers. As healthcare evolves and demands increase, nurses will continue to speak up and advocate for themselves and their patients. The best way to positively affect the nursing shortage and burnout is to listen to what the nurses and health care professionals are saying.  There is not one fix all for this solution. It is gonna have to be tackled company by company throughout the world.

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Despite nursing shortages being an issue for many decades in many countries, the global health crisis has impacted the profession significantly. Since the Pandemic, nurses have been exacerbated by its impact. Many nurses were left suffering from mental and psychological exhaustion, frustration, and loss of passion for the love of patient care; these symptoms left many nurses that were highly qualified, skilled, and with years of experience in the profession exiting their roles to venture into different opportunities that were less demanding and stressful. Haines (2022) reported that the proportion of nurses in the profession that are between the ages of 25 and 34 is the largest, but between May 2020 and May 2021, their numbers plummeted by 5.2%, while the second largest proportion of nurses in the age group between 35 and 44 plunged by an even greater 7.4%. Also, the aging population and the need for healthcare have increased the demand for registered and advanced practice nurses over the years; however, the increased demand for healthcare has led to caregiver burnout and turnover (Broome & Marshall, 2021). While many may have theorized that the current problem lies with the number of staff enrolled in the profession being on the frontline, it can be quickly concluded that the actual problem is simply the number of qualified nurses that no longer have the zeal and passion for providing patient care.

I work in the ICU, where my current state and concern for my license are at an all-time high. The impact of nurse shortages has seen nurses practicing unsafely as the nurse-to-patient ratio in a critical setting is unsafe and has caused poor patient outcomes and increased patient stay due to poor nursing practices. Due to the nurse shortages, nurses having to work longer hours further distort their nursing judgment, leading to an increased medication error, increased workplace hostility among staff, and an unsafe working environment. Decreased patient satisfaction is also a significant concern in my work setting because patients have to wait longer for services, e.g., pain medication, thus increasing their suffering. The healthcare setting I am affiliated with was once a magnet institution, which meant the level of nursing services provided was second to none; however, since the satisfaction rate has plummeted drastically due to nursing staff shortages, they no longer hold that status. Hospital-acquired infection such as Catheters-associated Urinary Tract Infection (CAUTI) has also increased due to poor management, e.g., Foley cares every 8hrs not being done, Central line-associated Bloodstream Infection (CLABSI) and Ventilator-associated Pneumonia (VAP) is also on the rise because of nurse shortages.

According to Haddad et al., 2022, nursing continues to face shortages due to a lack of potential educators, high turnover, and inequitable workforce distribution. Some of the social determinants that have been impacting the nursing shortages are burnout; this is so due to nurses having to work longer working hours to help cushion staff shortages in some facilities, e.g., in some institution, after working a 12hr shift, nurses are mandated to work an extra 4hrs because the facility is short-staffed. Technological advancement has seen people live longer due to new and improved ways to treat many illnesses.  Haddad et al. (2022) postulated that as the population ages, the need for health services increases, and currently, the United States has the highest number of Americans over the age of 65 than any other time in history, with statistics indicating that for 2029, the last of the baby boomer generation will reach retirement age, resulting in a 73% increase in Americans 65 years of age and older, 41 million in 2011 compared to 71 million in 2019. As the baby boom generation reaches retirement age, the population is aging, resulting in a greater need for health services. Another social determinant that has affected nurse shortages is violence in healthcare.  Verbal, physical, and psychological abuse are some of the hostility nurses face daily at the bedside leading to many nurses resigning as caregivers.  According to the World Health Organization (WHO), “between 8 and 38% of nurses suffer from healthcare violence at some point in their career” (Kafle et al., 2022). Because of how common violence and abuse against nurses have become, it has not only led nurses to exit their role in the profession, but its impact has decreased productivity and patient outcomes.

Dr. Brenda Freshman has alluded to the notion that to address future challenges in healthcare, the most crucial thing leaders can do is develop cultural competency, the ability to take multiple perspectives, and a greater understanding of the whole system of the organization (Walden University, 2015).  To help alleviate this issue, my healthcare facility has tried to hire outside recruiters with attractive and competitive pay packages that attract travel nurses to sign a contract for 13-26 weeks and work a 48hr work week. The organization has also hosted job fairs to lure in recent graduates and nurses interested in working for an attractive compensation package with an enormous sign-on bonus for up to three years. Further measures taken by the facility to combat nurse shortages include the implementation of up staffing and mandatory on-calls. To retain their current staff, they have been considering retention bonuses that will help to prevent their highly trained and qualified nurses from resigning. Another effort by the organization to address nurse shortages is the impending introduction of remote nurses, who will support bedside nurses and give them greater flexibility in providing better care for all patients. Finally, more grants and scholarships are introduced for nurses to continue their education, which has seen many nurses capitalize on this opportunity to help boost their morale, which benefits the organization in the long run.

The Healthcare system has suffered immensely since covid, and the aftermath has left many healthcare workers struggling to continue their work at the bedside. The demand for healthcare services has caused more stress to nurses, and as such, despite measures implemented, nurses are still abandoning their roles for jobs that have less stress and demands.

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Review of Current Healthcare Issues

Depending on who you ask, answers will vary significantly on what is thought to be the most significant issue facing healthcare today. As nurses, it is important to stay up to date on these national issues so that understanding and implementation can be translated into the workplace. The purpose of this discussion post is to select one current national healthcare issue to reflect on and to think about how it is addressed in the workplace setting.

Nursing Shortages and/or Appropriate Staffing

In America, the total number of working registered nurses is about four million (Baker, 2022). Historically, there have rarely ever been enough nurses to act as a supply for the demand of services needed. Recently, with the COVID-19 pandemic, the supply of registered nurses has decreased while the demand has significantly increased. This is due to many reasons. Some nurses have gotten ill from the pandemic and have not been able to return to work while others have chosen to retire to avoid being surrounded by COVID. Another reason includes burnout and turnover from this increased demand (Broome & Marshall, 2021). When there are not enough nurses available to be scheduled on a unit, organizations are forced to use short-term solutions to provide appropriate care. Some of these short-term solutions include the use of agencies to supply travel nurses as well as bonuses for those already on the payroll (Chervoni-Knapp, 2022). These are considered short-term solutions as they ultimately are not sustainable for organizations to be involved in for a long period of time (Chervoni-Knapp, 2022). Organizations are faced with this tough choice as the alternative of not enough nursing staff would mean that fewer patients are cared for and less money is made for the company. This could result in entire organizations having to shut down which then would lead to significantly fewer beds available for those who are sick. As you can see, there is no perfect solution for this problem and most organizations are trying their best just to get by.

Workplace Impact

I have worked at an inpatient psychiatric facility since 2019. It has been an interesting experience to work before COVID, during COVID, and now, while COVID is decreasing. Before COVID, the unit where I worked was always appropriately staffed, if not overstaffed, on each shift. I remember being canceled every so often as we consistently had more than enough nurses to care for the patients. During COVID, there seemed to never be a day that enough nurses were working. My workplace utilized travel nurses and registry agencies to maintain adequate license-to-patient ratios. A downside to this short-term solution is that for one, these nurses cost a greater amount of money than regular staff nurses do due to the demand as well as these nurses are not familiar with the unit or the company procedures and need time to learn. These downsides created an upset in the unit where I worked. Now, since COVID has been decreasing, my unit has not needed to use travel nurses or agencies to staff it appropriately. We still are not always fully staffed, but accommodations have been made. One is that the organization offers bonuses to staff to come in on their day off if the unit is short. Another is that if another unit has extra staff, they will be floated to my unit for the day to help out. This has been working enough for the past few months. I hope to see soon where the unit starts becoming adequately staffed again.

Conclusion

In conclusion, national nursing and healthcare issues are prevalent throughout America. Every nurse and organization will have an opinion on what they believe is the most significant issue. This being said, the issue of nursing shortages and struggles with appropriate staffing has been endured by most due to the COVID-19 pandemic. Overall, nurses should be educated and aware of these issues so that complete understanding and change can occur.

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As many of us pursuing degrees as advanced practiced registered nurses (APRNs) know, despite receiving an expansive education to provide care to patients, the state that we choose to practice in, its laws and regulations, will affect to what capacity we are allowed to practice and utilize the skills we have learned (American Association of Nurse Practitioners, AANP, 2022). Although strides to expand scope of practice for APRNs have evolved over the years, there are still limitations. These limitations are problematic because of shortages in healthcare professionals, particularly advanced practitioners. As Poghosyan et al. (2018) discusses, for example, that more than 50,000 physicians will be needed by 2025 to meet the demand for primary care but the number of physicians are decreasing while the number of nurse practitioners (NPs) that could potentially fill these gaps are increasing. Health care disparities and inequalities are not new topics, but in this world of Covid-19, these disparities and inequalities, the social determinants affecting them, and the resulting patient outcomes have been highlighted and emphasized (Heath, 2020). Heath (2020) continues to state that health inequalities are rooted in the social determinants of health because they can limit an individual’s ability to achieve optimal health and wellness.

For this issue, the social determinant most involved in this topic is health care access and quality, specifically access to time effective and “high-quality health care services,” because limiting the nurse practitioner’s ability to practice to the full extent of their education and knowledge limits how they can be adequately used in every community to contribute to the availability of health care services to the members of those communities (U.S. Department of Health and Human Services, HHS, n.d.). Nurse practitioners can play an important role in addressing this issue not only because of the increased numbers of nurse practitioners in the workforce but also because of the nursing approach founded in holistic patient care, building a connection with patients, and practicing with compassion and empathy (Heath, 2020). Expanding nurse practitioner scope of practice regulations can allow them to work to their full potential, fill in gaps in care that physicians are unable to, and provide care to the millions in communities with limited access to primary care or other care. For example, the ten states with the most flexible nurse practitioner scope of practice laws and regulations have some of the best overall health outcomes while the ten states with the worst overall health outcomes have the strictest laws and regulations regarding nurse practitioner scope of practice (Heath, 2020). Broome and Marshall (2021) also discuss how APRNs are a resource that should be utilized fully by referencing a study in which “the addition of nurse practitioners (NPs) to an inpatient care team at a single site demonstrated enhanced revenue through gross collections and cost efficiency, reduced overall lengths of stay, and standardized practices to improve quality of care” (p. 71).

As a travel nurse, I see the workings of many different facilities and how functioning with limited staffing versus adequate staffing can affect team communication, timely patient care, and patient outcomes. The lack of more autonomous APRNs in the inpatient setting, from my experience, leads to longer wait times for patients and bedside nurses to hear from the care team about issues that arise and to participate in care team rounds that require the physician to be present. Of course, bedside nurses can call, page, or message the physician, resident, intern, or even the physician assistant if applicable but typically nurse practitioners are not utilized as a functioning, decision-making part of the team which would be valuable. For example, I have had patients complain about feeling neglected by their physician because no one was able to round with them for a day/a few days or that no one from the care team came to see them until late in the day because the physician and team of residents and physician assistants were busy with other patients and tasks. A nurse practitioner may have been helpful to fill these gaps. Also, because nursing education is grounded in a holistic approach at every level, their input may provide a different perspective to the care approach and decision-making that may improve patient-provider relations and patient outcomes. Again, as a travel nurse, I do not have much insight into organizational changes or initiatives because of the limited amount of time I spend at each facility, however, at the current facility I work at in California I can honestly say that I have not heard of any initiatives to alleviate this issue during huddles or unit meetings. I cannot recall interacting with a nurse practitioner at this facility at all. From what I have heard from staff members, this Kaiser facility does not utilize nurse practitioners at all or very rarely. This may be a consequence of California state law and/or specific Kaiser policies in this region. This facility could greatly benefit from utilizing nurse practitioners from my experience as I have had the pleasure of working with APRNs in my home state of Pennsylvania; they serve as an invaluable resource and bedside nurses and physicians alike relied on their expertise greatly. As Poghosyan et al. (2018) reports, many physicians believe that nurse practitioners are competent members of the care team that can expand the capacities of health care practices and help meet the increased demand for quality patient care.

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National Healthcare Issue/Stressor – The High Cost of Health Care

Healthcare expense in the United States is among the highest in the world compared to other developed nations. The US spent 4.3 trillion dollars on healthcare in 2021, or around $12,900 per person, according to Peter G. Peterson Foundation (2023), compared to other first-world countries that only charge around half as much for healthcare per person. Healthcare expenses have risen over the past several decades relative to the size of the economy, from 5% of GDP in 1960 to 18% in 2021 (Peter G. Peterson Foundation, 2023). The rising aging population and healthcare costs are the two most significant drivers. The proportion of Americans aged 65 and older has increased considerably (Broome & Marshall, 2021). Americans over 65 spend more on healthcare than any other age group because of age-acquired illnesses. The cost of healthcare services frequently increases more quickly than the cost of other goods and services. The Consumer Price Index (CPI) for medical care has increased by 3.4 percent annually.
The introduction of cutting-edge, innovative healthcare technology that results in better but more expensive services and products; organizational waste in the insurer and provider payment systems may be brought on by the complexity of the American healthcare system; and hospital mergers may bring about a lack of competition and a monopoly that attracts high prices are a few additional potential causes for the rise in healthcare costs (Peter G. Peterson Foundation, 2023). One-fourth of people report delaying or skipping care due to cost, making costs a significant barrier to access. High healthcare costs sometimes prevent people from getting essential care or finishing their medications. They have missed doses, cut pills in half, or not finished prescriptions in the last year, with more significant percentages among those with lower incomes (Montero et al., 2022).

Impact on Work Setting

The hospital had noted a tendency in some patients who could not pay for care when they first sought medical attention and later learned they had severe illnesses due to delaying or skipping medical visits for routine checkups, therapy, or rehabilitation following surgery or a treatment, aftercare, or an inpatient stay. As a result, of the high cost of medical treatment, patients’ health deteriorated, and undiagnosed or untreated medical conditions developed worsening symptoms, necessitating additional, more expensive therapies that would only worsen the initial problem causing these patients to be admitted to the hospital (Experian Health, 2022). There are more patients with serious issues who, if appropriately managed as outpatients, may have avoided admissions to emergency room (ER) services for medication-related diseases that escalated because they missed doctor appointments. It often results in a needless ER admission, which raises medical expenses since ER treatments are generally expensive (Rakshit et al., 2023). As a result of unpaid medical bills, calls to patients to inform them about outstanding debts for at least 120 days before pursuing extreme steps have increased. Invoices are subsequently forwarded to a collection agency when all available payment alternatives have been offered to the patients and have yet to be taken advantage of have been seen. Patients with medical debt hospitalized for stress and high blood pressure are becoming more common in this hospital (Rakshit et al., 2023). Due to the high cost, it is found that some patients are thinking about switching providers and moving to a location with lower costs. When patients fail to appear for their appointments, it jeopardizes the quality of medical services. It affects resource efficiency, resulting in a loss of projected income in services, interfering with medical processes, and wasting time and resources.

Social Determinant

The effects of high healthcare costs are felt most acutely by those without insurance, those of color, and those with lower or no incomes who lack healthcare resources to obtain health insurance or pay for expensive procedures and prescription drugs. Some people claim that they cannot afford specific forms of therapy and delay or skip receiving medical care due to the cost (Montero et al., 2022). Individuals who reside in rural areas, belong to specific racial and ethnic groups, are physically disabled, or are members of specific communities are more likely to struggle financially to pay for expensive healthcare. Institutional racism and discrimination lead to disparities in social and economic opportunities and resources. The resources necessary to ensure a high quality of life, such as healthcare programs like Medicare and Medicaid, are typically inaccessible to those in disadvantaged areas. Unfulfilled social needs, environmental factors, and barriers to seeking medical care, such as high expenses, all contribute to worse health outcomes. Poverty can limit access to educational and career opportunities and widen the wealth gap, creating a vicious cycle of poverty and the inability to pay for adequate healthcare. The risk that an individual would experience poverty as an adult rises due to childhood poverty, which feeds poor generational cycles (H HS, n.d.). People without access to quality education throughout their lives are more likely to find themselves in difficult financial situations, making it more challenging to afford quality healthcare. The likelihood of finding higher-paying occupations with fewer safety dangers increases with education. More educated people ultimately have more significant financial resources to pay for and receive high-quality healthcare.

Health System Work Setting Response

Being a non-profit hospital, the healthcare system where I work provides treatment for those in need, regardless of their financial situation or state of health. No matter what medical challenges a patient may encounter, they can obtain the best care possible because of their financial support and other measures they have put in place to help pay for medical bills. The hospital’s billing office telephone number allows patients with financial difficulties to call and discuss options like a payment plan or financial aid. These services for financial support consist of fair and standardized billing and collection procedures, such as Charity Care, financial aid policies, and a standardized application procedure. Once a patient is eligible, their Charity Care programs are utilized to pay all or a portion of the hospital charge. There is also a payment arrangement with zero interest and extended payment plan choices for patients who owe medical bills to pay off their debt affordably. This hospital provides a minimum monthly payment of $25 for 36 months. This enables people with high medical costs to stay compliant with their medical care and has a positive societal impact (Parkview Health, n.d.). This hospital prevents surprise medical expenditures by providing patients with realistic pricing projections. Clear and precise estimates are provided to equip patients better to arrange their finances and make treatment decisions. The estimates are provided to patients through an easy-to-use self-service website (Parkview Health, n.d.). Despite budgetary limitations, this hospital also provides emergency care. It is one of 12 grant recipients countrywide who must get money to develop its Medication Assisted Treatment (MAT) clinic program, with aims to treat drug addiction disorders, notably opioid misuse disorder, by offering free medicine, counseling, and behavior therapy to patients who would not otherwise be able to pay for their prescription medications (Parkview Health, n.d.). Employee discount offers a variety of healthcare goods and services to its employees and beneficiaries. Also, this hospital employs social workers and medical professionals who inform patients of outside resources they might use for assistance. With case management, patients may set up Medicare and Medicaid programs. They have pharmacy discount cards available and provide information about healthcare facilities like Matthew 25 Health and Care, a gospel-inspired medical facility. They offer high-quality medical and psychiatric services free of cost to low-income, uninsured adults, bringing joy to the most vulnerable in the neighborhood by treating them with kindness and dignity despite their socioeconomic status or religious views (Matthew 25 Health and Care, n.d.).

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Healthcare Issue/Stressor-Nursing Shortages and Quality of Care

            Every day, nurses are expected to do their job and do it to the best of their ability. I currently work in a clinic setting, and we are adding more and more clinics. Each nurse has clinics they are specifically assigned to. But what happens when they keep adding more and more, and we only are allowed a certain number of employees? Well, I can tell you that we will have to work those clinics and care for those patients. The biggest question that comes to mind, though with that, is how thin can staff be stretched? We run into issues such as insufficient time to room patients and get a full health history appropriately. So then, what are we missing that we should be aware of. That, for example, leads to quality-of-care issues. As a patient, I know I’m not the only critical patient that day of my visit, but I know I’d like to feel like they are dedicated enough to learn and know my whole story, problems, etc., to develop a plan of care. The example listed above is only one example of how nurses are shorted and overworked many times, and in turn it lacks on the patient care end and providing quality care simply because they do not have the time.

Many reasons have caused staff shortages, but today, one can think that the COVID-19 pandemic did not help the situation. Any nurse that worked through it probably wanted to run away from it. Most healthcare entities had difficulty staffing their facilities during the pandemic, especially in rural communities. Nurses being short staffed causes increased mortality rates, length of stays and hospital readmissions, patient safety problems, errors, lack of quality of care, and wait times (Norwich University Online, 2020). The nursing field continues to experience exhaustion and burnout. The nursing turnover nationally ranges from 8.8-37%  (Haddad et al., 2022).

Social Determinants

            Social determinants of healthcare are the patient’s financial situation, their level of education, employment status, work and home conditions, ability to get food, age-appropriate development, social situation, and affordability and accessibility to quality of care (World Health Organization, 2018). When speaking of quality care, all the social determinants of care can be quality factors. Specifically in our clinic, financials are a bit problem, especially when it comes to getting medications that are prescribed. Thinking back to a specific example of a patient not being able to afford simple over the counter medications for a colonoscopy. We then had to send in the MiraLAX and Bisacodyl through insurance because they could not pay for them through food stamps. Many of the patients with low socio-economic status’ do not receive the preventative care they need until major health problems arise, and that is when we see them more in the clinic in one or more department. This is, in turn increases patient loads because of the many appointments that they have in the clinic or even some patients we have come in for daily or even twice daily antibiotic infusions, which we must work our other patients around. Again, going back to only so many staff nurses, being shorthanded, affecting the quality of care, and needing time to care for each patient appropriately.

Response

            Our clinic setting has taken a team approach in this staffing issues. We stay central to our clinics to maintain continuum of care, a positive aspect of quality of care. We have had to learn new clinics to ensure their patient load is appropriately cared for. In our downtime, we get into the inbox and promptly respond to patient calls, refills, and results notes. Hopefully, we will also add a specific nurse that can take care of prior authorizations, med refills, result notes, patient notification, etc,. That way the rest of the nurses can focus on patient care. We also have a manager that genuinely cares about quality care and how the clinic runs. She also assists in getting PRN help when needed as well. Many aspects make up quality patient care, and just because we are short staffed and they are adding more and more clinics does not mean that we cannot provide the best care around. I would compare our approach to the core competencies of teamwork, values, responsibility, knowing our clear roles, and communicating with one another (Broome & Marshall, 2021).

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National Healthcare Issue/Stressor

The national healthcare issue/stressor I have chosen is COVID-19 and personal protective equipment. Any change in a work setting comes with pushback. In healthcare change is inevitable and learning how to cope with change while delivering effective care is necessary for healthcare professionals (Broome & Marshall, 2021). COVID-19 was a change that was unexpected and led to massive changes in a short amount of time. Hospitals and healthcare facilities were not prepared for a pandemic and PPE was in high demand. COVID-19 caused stress for healthcare workers due to lack of resources, unsafe working conditions, long working hours, stress of exposure, and PPE that was uncomfortable and hard to work with (Evcili & Demirel, 2022).

Impact on Work Setting

I currently work in a peri-op setting and before COVID we were only required to wear PPE when the patient had a known respiratory illness or if was required due to a different isolation reason such as C-Diff. Due to COVID, we now always wear masks in pre-op and PACU. When COVID was at its peak, we had to always wear N95s and protective eyewear. Our health care system still requires staff and patients to wear a mask. Many people have pushed back and have left to other systems in the state who do not require staff to wear masks.

Social Determinants

Social determinants that have been affected due to COVID and PPE are working conditions and medical care. COVID has made working conditions stressful for healthcare workers and being in PPE 12 plus hours a day is very uncomfortable. PPE and COVID at its peak, affected the care patients received because nurses had to learn how to reprioritize their work and provide tasks for many patients at a time. COVID-19 has led to missed nursing care and leads to longer lengths of stay for patients and higher rates of readmission (Khrais et al., 2023).

Health System Work Setting Response

COVID has affected all healthcare workers in some way. Healthcare is still recovering from it. There has been recent talk in my healthcare system that masks will not be required anymore due to push back from patients/staff. Our organization currently does not require them in a non-clinical setting. I will be interested to read if other healthcare systems still require them in other states from all of you!

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Staff Shortage in Long-Term Care Facilities

The national issue of nursing and primary care provider shortages constantly impacts work in my healthcare settings of long-term care and rehabilitation facility within the ProMedica healthcare organization. Ricketts and Fraher (2013) noted that the nursing shortages pattern resembles a sinewave prompting policy development that “stimulates rapid growth leading to surpluses” (p. 1876). Periera and Bowers (2021) confirmed that “the nursing supply between 2014 and 2030 is expected to exceed demand, with a projected surplus of 293,800 RNs by 2030” (p. 83). Despite these projections, the skilled nursing facility (SNF) where I work constantly experiences workforce shortages in nursing assistants, nurses, and primary care providers. The nurse-patient ratio of one-to-thirty instead of one-to-twenty became the new normal, inevitably resulting in diminished quality of patient care, patient dissatisfaction, and staff burnout. The continuous effort of Human Resources to hire new employees does not have much effect on adequate staffing either due to high turnover rates. According to Periera and Bowers (2021), “turnover of nurses within healthcare organizations is common, with 20% of nurses leaving their job within the first year of employment” (p. 84). Therefore, to maintain sufficient staffing and uninterrupted work of the facility, reorganizational strategies should be implemented beyond simply hiring new employees.

According to Walden University (2018), the Triple Aim of healthcare, which is increasing access to healthcare, improving clinical outcomes, and reducing the cost of healthcare delivery, was converted to Quadruple Aim with added focus on environmental effects that include work life and provider experience improvement (Walden University, 2018, 1:15; Periera & Bowers, 2021, p. 69). Hence, one of the reorganizational strategies and health system work setting response to the healthcare issue of staff shortages would be enhancing employees’ well-being and experience. Jacobs et al. (2018) noted that “making well-being an organizational strategy could be a way to improve employees’ lives while achieving organizational outcomes” (p. 232). The authors overviewed Anne Arundel Medical Center’s approach to enhancing employees’ well-being, including educational opportunities, career development, social, financial, and physical expansion, and assuring community support (pp. 236-237). ProMedica healthcare organization also provides diverse programs to support employees in their daily work life, particularly during hardship times. Thus, ProMedica launched Employee Assistance Program (EAP) that offers mental health counseling, stress management, substance abuse consultation, solution support, and is open for employees 24 hours via telehealth, phone, or in-person counseling (ProMedica, 2023). Additionally, ProMedica ensures employees’ wellness via 24/7 telehealth support for adverse health conditions, unemployment protection, and family/parental support.

Another reorganizational strategy and health system work setting response to staff shortages would be engaging the nurse practitioners (NP) workforce to support primary care providers. Norful et al. (2018) noted that one of the reorganizational models “includes having more than one primary care professional comanaging the same patient and sharing the workload responsibilities or care management tasks” (p. 250). The authors noted, however, that current legislation and organizational policy restrict nurse practitioners’ authority leading to a “physician-led hierarchical infrastructure in which the physician has the final decision-making authority” (p. 252). The authors further collaborated that perceived NP lack of authority can be mitigated by NP-physician shared philosophy of care, mutual respect and trust, and effective communication, which, in turn, will be beneficial “to meet demand of patient care” and alleviate “individual provider workload” (p. 253). Lovink et al. (2017) confirmed that the collaborative work model of NPs and physicians and even the substitution of elderly care physicians (ECPs) by NPs, physician assistants (PA), or registered nurses (RN) is possible if NPs, PAs, and RNs are supported by management and physicians, “collaborating with the ECP based on trust, [and] sharing the same views with the ECP on good resident care” (p. 9). The SNF where I work is at the beginning of adopting this model. With only four primary care physicians for a 200-bed facility, organizational management attempts to assign certain patients to third-party organization nurse practitioners who work discordantly with the facility’s permanent physicians and nursing staff. More efforts should be made to advance the education of already employed RNs to NPs and promote collaborative work with primary care physicians in the facility.

Finally, working synergistically with educational underprices and providing a launching base for new nursing assistances and nurses can serve as an additional reorganizational strategy and health system work setting response to the healthcare issue of staff shortages. According to Jean (2022), such innovative approaches as “training new technologies, […] providing a ‘flexible workforce,’ [ensuring] personalized educational opportunities, […] or providing tailored educational opportunities” are effective ways to address healthcare personnel shortages (Using Innovation to Address the Nursing Shortage section). The author pointed out that the nurse residency programs effectively combine learning opportunities for nurse novices and fill in the gap of nursing staff shortage (Using Innovation to Address the Nursing Shortage section). For example, the SNF where I work effectively uses its settings as an educational platform to prepare nurses and nursing assistances. Many students who graduated from local community colleges decide to apply for a job and continue working in an already familiar environment.

Therefore, searching for working model reorganizational strategies, such as enhancing workforce well-being, promoting a collaborative approach of NPs, RNs, and physicians to centered patient care, and enhancing educational opportunities in both ways offering tuition reimbursement programs and serving as an educational practice site, is an effective way to recruit new healthcare team members and retain the already existing workforce.

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The challenge of training nurses has been a national healthcare issue in the healthcare industry. Having well-trained nurses is essential to ensuring patients’ highest quality of care. It contributes to ensuring that nurses have the information and abilities needed to effectively carry out their tasks and care for patients in line with accepted standards of practice. Efficient and effective clinical training for nurses is required to ensure that healthcare is provided efficiently (Will et al., 2019). Although the lack of enough skills for nurses is particularly pertinent in the rapidly changing technology environment and increasing complexity of care delivery, this issue must be addressed (Ricketts et al., 2013). This issue can potentially impact my work setting as it could lead to making mistakes in delivering medical care, resulting in poor patient outcomes, incorrect diagnoses, incorrect medications, or even missed symptoms that can have serious health consequences.

In my work setting, we have responded to this issue in several ways. First, our organization has provided ongoing training and workshops for nurses. This training focuses on the role of nurses and the importance of collaboration and communication. We have also implemented an electronic health record (EHR) system to help streamline the workflow and reduce the burden on nurses. The (EHR) system has improved the quality of care, lowered costs, and improved productivity by making care more efficient and effective (Negro-Calduch et al., 2021). Finally, we have implemented several initiatives to increase nurses’ satisfaction, such as flexible scheduling, mentoring programs, and educational opportunities. In conclusion, this challenge of training nurses must include regular workshops and conferences, implementing an EHR system, and improving nurses’ satisfaction. Our firm is working to guarantee that healthcare is delivered effectively and efficiently through these ways.

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Review of Current Healthcare Issues

             Nurses make up the largest section of healthcare professionals and according to the US Bureau of Labor Statistics, the need for nurses is expected to grow from 2020-2030 (Haddad et al., 2022). Possible causes of the current nursing shortage include, lack of educators and high turnover rate. With the aging of the baby boomer generation, there will be an increase need of care for the elderly, as their health progresses. Another factor that lead to our current nursing shortage is the Covid-19 virus, this virus increased the demands for nurses and the volume of patients being seen (Turale & Nantsupawat, 2021). The purpose of this discussion post is to discuss the national nursing shortage and how it affects my workplace.

Nursing Shortage Impact on Emergency Department

             In the emergency department we see critically ill patients every day, and it is our job to triage and appropriately place the patient where they need to go. This can be challenging when there is an increase in volume of patients in the department and a shortage of nurses to care for them. Nursing shortages in the emergency room increase the door to discharge length of stay and increase the number of patients that leave before being seen (Ramsey et al., 2018). Some social determinants affecting the nursing shortage are stress from increased workload, and negative effects on mental health. Another determinant is the Covid-19 virus and nurses fear of infection and possibly death (Turale & Nantsupawat, 2021).

Workplace Response to Nursing Shortage

             My workplace has made many efforts to increase nurse retention, hire more nurses, and decrease nurse workload. My workplace is offering nurses a ten thousand dollar sign on bonus in exchange the nurse has to stay at my organization for two years. The first half of the bonus is given after their first ninety days and the other half after one year. For their current employees they are giving them yearly raises, annual incentive bonuses, and a bonus for extra shifts worked. To help decrease the nurses work load the emergency department has hired medics to help with tasks like, IV insertion and triage. Lastly, to eliminate unsafe nurse to patient ratios, they hired travel nurses to fill in holes in the schedule. In conclusion, with my employer taking these steps to improve the nursing shortage, we have already seen an improvement in the department.

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The national healthcare issue and stressor I selected for analysis is the nursing shortage. When we dissect the healthcare team in the hospital setting, the majority of these professionals are nurses, who play a crucial role in healthcare. Since the pandemic hit in 2020, the nursing shortage has been growing and continues to be a huge concern. The US Bureau of Labor Statistics projects that more than 275,000 additional nurses are needed from 2020 to 2030 (Haddad et al., 2022).

I currently work in the emergency department of a small rural hospital and the nursing shortage has affected us tremendously. We have a total of 22 beds which includes two code/trauma/treatment rooms. One of these rooms is designated for the providers, and two are for storage. So, we technically have 17 rooms for patients in total. As of last August, our MOSU unit closed due to the nursing shortage, so the ER also rooms observation and admitted patients. The staffing for our shifts is one charge nurse, two nurses, one provider, and three days a week one HUC. To give a better idea of how stressful this can be I will provide an example. Last week we had a total of nine admits which left us with eight beds total for ER patients. Keep in mind, this means each nurse has three holds and must also take care of the patients that come into the ER.

With that being said, we have recently been informed that all but two of our doctors will be leaving. The number of patients the providers had to see was already high and the fact that we have to house the holds makes it even worse. These providers are stressed out and could have had some relief with a midlevel provider.  The number of NPs and PAs is growing rapidly, in part because of shorter training times for such providers as compared with physicians and fewer institutional constraints on expanding educational capacity (Auerbach et al., 2018). The nurses in the emergency department are burned out and really need more help too. You would think the hospital would offer some kind of incentive for working under these conditions, but they don’t.  Cecilia K. Wooden from the Walden University (2015) video states that velocity and vitality are important aspects of balancing work-life balance. She states that the workload we encounter causes stress, and we need to balance that with utilizing employee wellness programs to avoid burnout.

Social determinants that affect this healthcare issue are nursing burnout, location, and the low pay offered at this hospital. In this hospital, ER nurses are also practicing as floor nurses and most have never done that which can be stressful and pose a risk for the patient. This hospital is also over an hour away from the city and most people don’t want to make the drive there. The company needs to increase the pay to make up for the drive these nurses would have to make, and they don’t. As stated above, they also don’t have any kind of employee incentive programs for anything. Nursing burnout is very high here due to all of this. According to Jacobs et al., 2018 “Engaged employees who feel cared for by their employer through initiatives like our WellBeing programs positively influence an organization’s performance”.

The admin and nursing director haven’t done much to try and help alleviate these problems. The most they have done is place an ad online to their facebook page to advertise job openings. They haven’t even offered anything to the providers that are leaving. The quadruple-aim study includes provider satisfaction, and this hospital does not follow this aim at all.  In an effort to address these aims, healthcare leaders must identify new priorities not only for healthcare delivery but to improve the work life of the members of the healthcare team (Broom & Marshall, 2021).

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Healthcare Issue/Stressor and Impact on Work Setting

Lack of access to healthcare has always been an issue healthcare organizations have been combatting for years. Before the pandemic, there was a multitude of social determinants that created barriers to access to health care. The pandemic, however, was clearly the most significant determinant that destroyed access to healthcare exponentially compared to the determinants that were already an issue previously. This impacted the work setting because there was an increased demand for emergency services since many patients needed help to follow up with primary care providers or specialists. My hospital stopped elective procedures from having rooms for critical patients with life-or-death necessities. Staffing shortages became an issue, and we began to notice decreased patient and worker satisfaction due to higher nurse-to-patient ratios and increasing demand for nurses and doctors. Despite the significant increase in demand for medical services, the supply of medical professionals is not growing fast enough to keep up with the demand. Physicians need to outsource their work, new technologies are being developed and more duties are falling on APRNs and clinicians that are not physicians (Auerbach et al., 2018, p.2358-2360).

Social Determinants Affecting this Healthcare Issue

Covid-19 was the primary determinant preventing access to healthcare, and facilities had to pivot with their technology to remain current and competitive. However, before covid-19, there were other determinants facilities were already taking actions to reorganize processes to improve outreach and services to the sickest patients. . Income and poverty restricted access to those individuals who were struggling to afford services or medication and could also limit access to transportation to healthcare facilities. Low education levels affected access due to illiteracy which sometimes delayed seeking healthcare services until problems progressed. Location and proximity to services hamper access and have always been an issue if patients travel 1-2 hours to see their providers. As you can see, the Roe vs. Wade situation currently limits access to reproductive services for women. There have always been social determinants that need to be combatted to improve access for our population with a focus on minority groups and the underserved long before covid-19 turned off all the lights. Systems need to be altered at times which sometimes means certain tasks need to be outsourced and loosely controlled or remain in house and tightly controlled by the faculty. Creativity and flexibility in new processes is key to be able to adapt effectively (Pittman & Scully-Russ, 2016, p. 2-3).

How Work Setting has Responded to this Healthcare Issue

In combatting these social determinants leadership needs to get creative and evolve with the times to ensure their business will continue to grow through the difficult times. New systems need to be developed to meet ever changing needs of the community in challenging times of change (Broome & Marshall, 2021, p. 35-36). My facility has increased access to telehealth services after discharge to monitor patients and ensure they remain proactive in their mental health and stay engaged in their care. Low-cost or free services are sometimes granted to low-income individuals and families who have difficulty paying for assistance but have critical needs for access to remaining focused and stable in the community. Telehealth has become the forefront of the next generation of healthcare, improving access to millions of people living in rural areas or hours away from the nearest provider.

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Nursing Shortage

National healthcare issues directly affect how a healthcare organization functions. One national healthcare issue directly impacting the healthcare organization where I work is nursing shortages. Nurses are a vital part of healthcare. From 2020 to 2021, the supply of registered nurses (RNs) decreased by more than 100,000, creating an additional strain on an already suffering healthcare system following the COVID-19 pandemic. Factors that contribute to the nursing shortages are nurse burnout, an aging workforce reaching retirement age, family obligations, a lack of nursing educators, and an aging population with chronic diseases. Nurse shortages affect direct patient care by creating high nurse-to-patient ratios, thus leading to increased medication errors, infection rates, higher morbidity and mortality rates, and increased nurse burnout. Also, nurse shortages affect direct patient care by limiting the number of hospital beds available to care for patients. A healthcare organization needs a nurse to care for its patients. The nursing shortage will leave hospitals with empty rooms due to limited nursing staff available. This causes hospitals to diverge patients to other hospitals and can decrease funding and reimbursements (American Association of Colleges of Nursing, n.d.; Broome & Marshall, 2021; Buerhaus, 2021; Jones & Spiva, 2023).

Impact of Nursing Shortage

The healthcare issue of the nursing shortage directly impacts my workplace healthcare organization by decreasing the beds available in the emergency department. Currently, I work in a rural healthcare organization. The closest level-one trauma center is over one hour, with limited ambulance services available. My healthcare organization is a critical access point for this rural area. The nursing shortages have decreased half the emergency department’s nursing staff, causing the healthcare organization to close over half the number of beds available. Thus, causing a delay in patient care and limiting the services available to the community (American Association of Colleges of Nursing, n.d.).

Social Determinants of Health

The social determinants of health most affected by the healthcare issue of nursing shortage are Health Care Access and Quality. The limited number of nurses available to care for patients and the financial strain that the nursing shortages had applied to healthcare organizations have decreased patient access to healthcare, especially in rural and low-income areas. Also, nursing shortages have affected the quality of patient care by causing higher nurse-to-patient ratios, thus leading to increased medication errors, infection rates, and morbidity and mortality rates (American Association of Colleges of Nursing, n.d.; Broome & Marshall, 2021; Buerhaus, 2021).

Responding to the Nursing Shortage

My healthcare organization has yet to succeed in responding to the nursing shortage. The only action they had implemented was a sign-on bonus with a one-year contract. However, their pay does not compete with other larger healthcare organizations in the surrounding areas. The administration is currently discussing and holding meetings with nursing staff and providers to form an action plan to retain and recruit nurses.

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Nursing Shortage
Description of the National Healthcare Issue/Stressor
The selected national healthcare issue or stressor is nursing shortages. A problem that hinders the proper dispensation of overall healthcare services. An issue of nursing shortages is where the nurses are fewer compared to the patient. The need for more nurses causes a strain on the existing nurses as they are expected to attend to more patients (Pittman & Scully-Russ, 2016). The demand and supply of nurses must be increased to cater to the population’s growing needs.
The identified healthcare issue has impacted my work setting. There have been complaints regarding poor working conditions, which have caused a decrease in overall nursing turnover. In this regard, nurses within my work setting have raised objections to significant amounts of work and few human resources to attend to the needs of patients. According to Hosseini et al. (2022), it is challenging to maintain nurses within an organisation when the working conditions could be better.
However, my organisation’s work system has made attempts to respond to the identified healthcare issues. One strategy employed in mitigating the identified problem is adopting a recruitment program. This strategy entails acquiring new talents who fit the organisational goals and requirements. The healthcare system has also attempted to develop a unique corporate culture that aims at empowering the existing nurses in a manner that will leave them feeling appreciated and motivated to carry out their delegated duties. These measures have proven significant in mitigating the identified issue and achieving patient safety and positive outcomes in care delivery.

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The national healthcare stressor I’ve selected is the growing nursing shortage. I think it’s safe to say that we all feel the weight of this stressor daily in our working lives. Many facilities, including my own, are constantly working short-staffed. We have an aging population with increasing complexities in healthcare needs and a decreasing supply of current and future nurses (Morris, 2022). In my state of Virginia, there’s only 10-12 nurses per 1,000 residents (Nurse Journal, 2020). This is dangerous for our patients and for us as nurses. Patients may not receive adequate care and nurses are at risk of losing their licenses due to unsafe practices and high ratios.

The main social determinant affecting this issue is geographic location. Many nurses are moving to hiring paying areas, leaving lower paying areas without adequate staff. Thus, leading to the rise in reliance on travel nurses and per diem staff. Contract hires are wonderful resources to use in times of need, however, it is so important to have a strong core staff to keep units up and running efficiently.

My facility has tried to combat this by hiring new graduates to practice in high levels of care and by taking advantage of travel and per diem employees. The practice of using travel and per diem employees is expected to rise to combat the nursing shortage overall (Green, 2023). New graduates can do well in higher levels of care IF they have adequate orientation. Unfortunately, due to the nursing shortage, many new graduates are being pressured to come off of orientation early. This can be detrimental to both the nurse and their patients. I would like to see my facility offer incentives for new hires and for current staff, as this is something that is currently lacking.

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War on Women’s Health:

On June 24, 2022, Rowe v. Wade was overturned by the Supreme Court, leaving it up to each state to decide whether the practice of abortions would be legal or not in their condition. This impacted our healthcare system, especially regarding women’s health, nationwide.

Restrictive abortion regulations in states can limit access to safe and legal abortion services. This can increase unsafe abortions, resulting in serious health complications and even death. Abortion regulations can also impact reproductive health outcomes, including unintended pregnancies, maternal mortality, and morbidity. This makes healthcare providers uneasy when it comes to providing care for these patients without being put at risk for legal and regulatory barriers to providing abortion services, which can limit their ability to provide the full range of reproductive healthcare services (Harris, 2022).

In the state of Ohio, which is the state I reside and practice as a Registered Nurse, abortion laws are more strict. According to (Field et al., 2022), “Ohio abortion regulations limit ob-gyns’ ability to provide comprehensive reproductive health care, creating ethical dilemmas for these physicians as they attempt to care for their patients. As Ohio’s abortion laws increase in number and restrictiveness, they further undermine obstetric and gynecologic ethical practice guidelines.” This can also impact the ability of healthcare providers to provide evidence-based care, which can impact health outcomes. The healthcare organization where I currently work often has to refer patients to other clinics in states where access to safe abortions is available to them when they need one.

Abortion regulations can also impact social determinants of health, such as access to education and employment opportunities, and can perpetuate social and economic inequalities (Carroll, 2022). These regulations can disproportionately affect low-income women, women of color, and those living in rural areas, who may have limited access to healthcare services and may be more vulnerable to the negative impacts of restrictive abortion policies (Redd et al., 2022). Women unable to obtain abortions may be forced to continue pregnancies unprepared, impacting their ability to work, attend school, and care for their families.

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How can the health profession address the needs of the many where there are only a few? The healthcare profession has faced a multitude of factors keeping up with the demand of the census. Ranging from meeting the population’s medical needs in rural areas or providing primary care to the overall census due to the shortage of physicians. Physician shortage may be due to extended training time vs. acute need for primary care and a lack of medical school capacity. In addition, the limited accredited residency position(Auerbach et al., 2018). In addition, the aging population of physicians shows that within the next decade, more than 2 out of every five practicing physicians will be over 65(Jubbal, 2022). The Association of American Medical Colleges projects the physician population will only increase by 0.5%-1% per year between 2016 and 2030(Auerbach et al., 2018, para. 2). However, researchers believe in offsetting the slow growth of the physician population, the number of physician assistants and nurse practitioners will continue to sour in development by 6.8% and 4.3% annually. Therefore, Nps and PAs contribute more than two-thirds (67.3%) of all practitioners between 2016 and 2030(Auerbach et al., 2018, para. 6).

Nurse practitioners are equipped with the education and capability to fulfill the gap between the need for clinicians and providing high-quality cost-affected care to the population in need. Some of the duties of a nurse practitioner are to assess and perform physical examinations, order and analyze cost-efficient diagnostic tests, consult fellow health professionals to aid in the treatment of the patient, prescribe the appropriate medications, and follow up on the individual’s status to reduce readmission and improve the patient outcome.

NPs consistently demonstrate similar or better outcomes than their physician colleagues across various health indicators(Buerhaus et al., 2015). However, “the increasing number of Nps alone will not address the deficiencies in primary care delivery because many policy and practice setting barriers affect Nps’ ability to offer services at the full range of their educational preparation and competencies” (Broone & Marshall, 2021, p. 77). Currently, 28 states out of 50 have limitations on the scope of practice for nurse practitioners mandating signatures for care to be signed by physicians.

Currently, I reside in Virginia. Virginia has a limited scope of practice for nurse practitioners. However, nurse practitioners and physicians provide comanagement upon treatment to patients, but the physicians have the final say in the direction of care management. I like this format from a new nurse practitioner aspect, but after becoming comfortable in my role. I want more autonomy.

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Nursing shortages and staffing concerns have been and continue to be major issues in healthcare. There are myriad reasons for staffing shortages in the nursing field. The aging workforce is seeing many more nurses retire than become new nurses. The nurses that remain want more time with their families. An increase in violence in the workplace, job dissatisfaction, and burnout are also some of the factors that lead to the lack of a nursing force worldwide (Haddad et al., 2022). One study suggests that by 2035 there will be a shortage of over twelve million nurses (Marć et al., 2018). More nurses are working in non-hospital settings such as Home Care, community health, and outpatient settings (Palumbo et al., 2017). This shift in locations of medical care is one of the contributing factors in the decline of hospital staff.

Nursing shortages are affecting all nursing fields, even the areas where the above study indicated the shift is helping. In my particular home care agency, we are currently looking for nursing staff for patient care. Despite offering more than the national average salary (Marć et al., 2018) we are unable to find qualified candidates. Due to the lack of appropriately qualified applicants, we are forced to make decisions between overextending our staff or curtailing patient interactions. Our agency has attempted to mitigate the stressors involved with nursing by implementing set hours of operation, focusing on employee wellbeing, increased training, and placing our nurses in the community where they live (Jacobs et al., 2018).

As I said earlier, there are many factors that play into the nursing shortage. Some of the determinants are a lack of educators to teach nurses, the regionality of the field, nurses retiring, more people needing care as the population ages, and an uptick in violence against healthcare workers (Haddad et al., 2022).

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Nurses are critical to the makeup of healthcare. As times continue to change the profession of nursing continues to face shortages as a result of a lack of education, an increasingly high turnover rate, and an unequal workforce distribution. Nurse burn out rates are increasing tremendously. Many times, nurses are finding that once they start their profession in healthcare, they then decide the career is not for them. The national average rates in the United States for turnover have increased from 8.8% to 37.0% (Haddad, et al., 2022).

I work as a labor and delivery nurse in a small community hospital. It is incredibly evident within my hospital; nursing burn out is real. Being that I work in a small hospital, it seems that more and more hats get added to our heads. Overtime, this creates hardships for nurses. Nurses feel they cannot care for the patient the way the patient should be cared for because of all the extra jobs being added to their already overflowing plate.

Social determinants of health (SDOH) are what impacts individuals’ health and well-being. Included within SDOH are economic stability, good quality and access to education, access to quality healthcare, access to opportunity of physical activity and nutritious foods, and safe housing (U.S. Department of Health and Human Services, n.d.).

The social determinants that most affect this health issue would be the determinants of physical and mental health. Healthcare professionals experience emotional exhaustion and a lack of confidence when physical and mental health is at stake. Addressing these social determinants of health can help by combating the healthcare burnout issue. (Heath, 2019).

My hospital has recently implemented sign on bonuses and retention bonuses to help with nursing burnout and nursing shortages amongst the hospital. The has helped because those who decided to sign must commit to a two-year contract. The hospital also worked to put together a serenity room for staff to use. These things have helped, but there is still a lot of other changes that need to be made in order to assist with this healthcare issue.

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Burnout and work-related stress

One national healthcare issue/stressor affecting my work setting is the nursing shortage, lack of supporting staff, and sudden changes that have led to burnout and work-related stress. Nurse burnout impacts patient healthcare outcomes and contributes to a poor work environment (Lajiness, 2022). I work at a military medical center, and most of the time, changes come down the pipe without the opinions of the staff involved. In 2020, when covid pandemic hit the world and affected the healthcare system, my ward was changed to be the designated covid unit. The ward was a locked unit, with no warnings and no training on the expectations of things to come. In 2022, when the war in Afghanistan was over, and the military base was closed, the injured Afghanis when brought to our hospital, and the unit was shot down again. Once more, we cared for patients who spoke no English, did not want women to touch them, and seemed hostile toward us. These two events created a lot of workplace-related stress and burnout. Leadership made all the decisions, and we had no say in whether we could support this mission. At the same time, most of the military staff were deployed to different states where the covid numbers were rising. So we were short-staffed and dealing with these changes. According to Hetzel-Riggin et al. (2020), one factor that affects the nursing shortage is an unfavorable and declining work environment which leads to job dissatisfaction. Nurses started looking for jobs in the outpatient environment where changes are predictable. According to Hetzel-Riggin et al. (2020), five different types of burnout symptoms can be observed: physical (such as sleep disturbances, headaches, and gastrointestinal problems), emotional (such as irritability, depression), behavioral (such as poor work performance, increased absenteeism), interpersonal (such as withdrawal from others), and attitudinal (such as callousness, dehumanization of clients/patients). One staff member retired, and two others left. Losing staff members with the skills set and experience is devastating and often leads to low-quality care and poor patient satisfaction.

Social Determinant

The social determinant mostly affecting this health issue is employee well-being. Jacobs et al. (2018) suggested that the work environment significantly impacts employee well-being, and employees with poor well-being were less engaged and more pessimistic about the workplace. The morale was very low amongst the staff. There was no trust in leadership, especially after we lost a staff member during the pandemic.

After our concerns were brought to the leadership and we had a unit meeting, the following changes were made;

• Our ward was removed from the list for any sudden changes without conversing with the staff.
• A quiet room with a massage chair was provided for us where we could go there to center ourselves.
• The lunchroom always had healthy snacks and fruits.
• Hospital-wide for civilians with at least one year with the federal government tuition assistance from $6000 to $8000 annually.
• Staff is allowed to use the gym and swimming environment during working hours if staffing is appropriate.

There is still work to do, but employee satisfaction has improved for now, and we celebrate each other. Patient satisfaction has improved; our unit has won the daisy ward twice.

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Health Insurance and Low-Income Population

One national healthcare issue that can affect family clinics is the lack of access to affordable healthcare services for low-income families. Many families who cannot afford private health insurance or out-of-pocket medical expenses rely on public healthcare programs like Medicaid and CHIP (Cha & Cohen, 2022). However, these programs may have limited coverage or may not cover certain services, leaving families with limited options for healthcare. This can strain family clinics, which often serve low-income populations and may be reimbursed at lower rates for Medicaid and other public insurance programs. Family clinics may need help providing the necessary care and services to these patients while balancing their financial needs.

The shortage of primary care physicians in certain areas can also affect family clinics, as they may need help to recruit and retain qualified healthcare providers. This can limit the availability of healthcare services for families in those areas and strain existing staff. Addressing these healthcare issues and improving access to affordable, quality care is crucial for supporting family clinics and ensuring all families have access to the care they need (Cha & Cohen, 2022).

Social Determinants

A lack of access to affordable healthcare services can affect several social determinants. To name a few,

• Health outcomes: Lack of access to affordable healthcare services can lead to poor health outcomes, including increased rates of preventable diseases, chronic conditions, and premature death.
• Economic stability: When individuals cannot access affordable healthcare services, they may face high medical bills, leading to financial instability and bankruptcy.
• Education: Lack of access to affordable healthcare services can impact education, leading to increased absenteeism and decreased academic performance.
• Employment: When individuals cannot access affordable healthcare services, they may miss work due to illness or injury, leading to decreased job productivity and loss of income.
• Social and community context: Lack of access to affordable healthcare services can impact social and community context by leading to increased stress and decreased social support, which can negatively impact mental health.
• Physical environment: Lack of access to affordable healthcare services can impact the physical environment by increasing exposure to environmental hazards and decreasing access to safe and healthy living conditions.
• (Artiga & Hinton, 2018).

The lack of access to affordable healthcare services can significantly negatively impact individual health and social and economic well-being.

 

Affected Workplace

Limited access to healthcare for low-income individuals can affect family health clinics in several ways. Family health clinics that serve low-income populations may experience an increase in demand for services as individuals who lack access to other healthcare options seek care. This can put a strain on clinic resources, including staff and funding. Many clinics need financial stability because of providing care to low-income patients who are uninsured or underinsured. These patients may need help paying for services or may be covered by public insurance programs that reimburse at lower rates, resulting in financial challenges for the clinic. Not only does it affect the clinic, but limited access to healthcare in low-income communities can also lead to challenges in recruiting and retaining qualified healthcare providers. Family health clinics may struggle to attract providers due to lower salaries or lack of resources, making it difficult to provide consistent patient care. Lastly, when low-income individuals cannot access necessary healthcare services, it can lead to adverse health outcomes for individuals and families. Family health clinics may see patients with more advanced or chronic health conditions because of delayed care, which can be more difficult and expensive to treat.

Healthcare for low-income individuals can significantly impact family health clinics, affecting demand, financial stability, staffing, and health outcomes. It is essential to address healthcare disparities and improve access to care to support the health and well-being of families and communities.

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The scope of healthcare delivery extends beyond disease treatment to include preventative care, routine checkups, and emergency care. Accessibility, shortages of medical professionals, antiquated equipment, and other problems all contribute to our country’s trouble in providing medical care to its citizens. Low quality of service and poor health outcomes, longer wait times to obtain care, harm to the institution’s image, a loss of patient trust, and a lack of accreditation are all direct results of healthcare delivery problems. (Broome & Marshall, 2021).

The organization has hired several APRNs to enhance service delivery in the face of physician shortages in primary care outpatient settings (APRNs). In Maryland, advanced practice registered nurses (APRNs) have the authority to conduct patient assessments, order and interpret diagnostic tests, make medical diagnoses, and launch and oversee treatment plans independently. They can also write prescriptions for drugs and treatments. These rules provide APRNs complete independence in the workplace and serve as a means of speeding up healthcare delivery. Healthcare delivery may be enhanced by resolving the problem of patient access to services. Integration of telemedicine services is one way to achieve this goal. In response to the COVID-19 pandemic, numerous healthcare facilities have used telemedicine, which has helped APRNs with triage services and improved high-risk patients’ access to regular treatment. Moreover, it has assisted persons with mental health conditions to maintain access to the necessary therapy services. Most importantly, it has allowed people with mental health issues to keep accessing the treatment they need via therapy (Smith et al., 2020).

Hence, the organization has hired nurse informaticists who have developed tools to improve healthcare delivery. According to Darvish et al. (2014), the new wave of technology has allowed new communication channels between doctors and their patients. Nurse informaticists utilize their knowledge to improve patients’ health, develop better healthcare systems, and make their jobs easier. A nurse informaticist develops software that facilitates electronic communication between nurses and other care team members, as well as between nurses and patients.

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Across the United States, there are many different healthcare issues that can affect workplace settings. One workplace setting issue or stressor that many are facing is nursing shortages and burnout. There has always been a need for nurses and a shortage, however since Covid-19 has come into play, the shortage/burnout has become more of an issue. With Covid-19 nurses are expected to work more days, longer hours and patient/nurse ratio has gone up. There are not enough nursing students that are passing school and able to join the workforce. Another part of this is nurses are leaving the field all together due to the constant stressors. I work in the clinic, however we see a shortage in nursing in the clinical setting as well. Within my rural facility, nurses are being pushed to do the job of 2-3 nurses during clinic hours while also maintaining patient safety. “The nursing profession continues to face shortages due to a lack of potential educators, high turnover, and inequitable workforce distribution” (Haddad, et al, 2022).

With a nursing shortage/burnout there is no one social determinate that is affected. All of healthcare and patients are affected by nursing shortages. With that said, one social determinate that is affected are psych/mental health patients. This field is already a low retention rate area to work and since the pandemic this number has increased. According to the American Psychiatric Nurses Association 2019, “More than 75 percent of all U.S. counties have a shortage of any type of mental health worker and 96 percent of all counties have an unmet need for mental health prescribers.” Since this, it has continued to become more of an issue.

Within my facility, they have had multiple different attempts in helping with nursing burnout/shortages. One of which is large retention bonuses. These bonuses are given in payments across two years. Our current largest bonus is $25,000 spread across the 2 years and I believe to be twice a year. The longer the staff is with the more money they receive. While this is a nice thing to have, it is hard to still work through the hard times of working shorthanded. Floor nurses are being called in on their days off and end up working 4+ 12 hour days instead of working their scheduled 3 days. Another way the facility is attempting to keep nurses is offering tuition assistance to go back to school. Once staff sign up for tuition assistance, they are signed in for one year after graduation or they must pay all the money back. Nurses are encouraged more and more to continue on with their education and more facilities are wanting BSN nurses vs RN’s. My current facility has specific colleges they help pay for and according to Gerardi, Farmer & Hoffman, 2018, “…employment-focused partnerships between schools and health care facilities that provide students with practice experience, promote greater use of the BSN, and create employment opportunities.” This is a great way to encourage nurses to continue on in their education and retain employees as well.

The nursing shortage is real and it is here to stay. With the increase in demand for nurses, nurses being unable to pass schooling or finding qualified schools to attend, the nursing shortage is here to stay. Because of nursing shortages, nurses are being put in unsafe situations not only physically and mentally for them but also the patients in which they see/treat. “Patient outcomes are affected by staffing shortages. High nurse-to-patient ratios can lead to medication errors and higher morbidity and mortality rates” (Morris, 2022).

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The national healthcare issue I chose to analyze was that of opioid addiction. This issue directly impacts the care of every single patient I see. Throughout the pandemic we started using more opioids to treat pain in our patients whether covid positive or just being seen for every day issues. Not only is dependency a huge issue with opioids but the number of overdoses has increased rapidly throughout the years.” More than 932,000 people have died since 1999 from a drug overdose.¹ Nearly 75% of drug overdose deaths in 2020 involved an opioid (“Data overview,” 2022). This directly affects my work setting for many reasons, we must make sure that the proper medications are being given to patients, in proper doses and that we don’t overmedicate or use medications the patient may not truly need. Social determinants that are seen with opioid use include but are not limited to, a person’s income, a person’s housing stability or living situations in general, education regarding the use and addictive properties of opioids (“Social Determinants of Opioid Use among Patients in Rural Primary Care Settings,” n.d.). As far as addressing this crisis in the healthcare setting, more physicians are less likely to prescribe opioids for generalized pain and prefer to use a multimodality form of pain control. This includes using heat and ice, using creams to address pain, lidocaine patches, alternating Tylenol and ibuprofen. While there are certainly situations in which opioids are needed a deeper look is being taken before just prescribing and giving these medications especially with patients who have previous abuse histories.

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In the field of Women’s Health, particularly Labor & Delivery, Antepartum and Postpartum care, the national standards of care and patient ratios are provided by AWHONN, Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN, 2022).  These standards of care, which include safe practice guidelines for patient to nurse ratio, are updated on a frequent basis.

Most large hospitals and teaching facilities adhere very well with patient:nurse ratios as set forth in the AWHONN guidelines, however there are exceptions when acuity and lack of staffing require the ratios to be tilted and the patient/nurse ratio to be overextended.  The Women’s Health Departments in smaller, more rural hospitals tend to not adhere to these guidelines, oftentimes causing very unsafe staffing ratios and place an overbearing load on nurses within their Women’s Health units.

Unit policies are created within each facility, sometimes policies are set forth by upper management that have never staffed the unit or understand how these guidelines are there to protect both patient and caregiver.  However on the other end of the spectrum there are hospitals that have policy makers that are all clinical staff.  The policies set forth by both nurse managers, attending physicians, and nursing staff are most often policies that are easy to follow, understand and provide the best patient care guidelines (ACOG, 2022).

Within each of the departments making up the Women’s Health Unit, both management and nurses often times participate in the leadership role and participate closely with policy and procedure.  Both in writing policy and preparing the procedural flow, nurses transition into a leadership role. According to Boome, “leadership is the ability to guide others, whether they are colleagues, peers, clients, or patients, toward desired outcomes” (Broome, 2021).  The role of the nurse is multifaceted, as with the policy and proceedure at different hospitals and facilities across the country,  As participants in the policy and procedure arena nurses take on the role as a transformational leader, where as nurse leaders one can influence others by changing the understanding of others, to what is important in the care of patients, family, staff (Broome, 2021).

Changing policy and procedure is a process. It is not just one thing, it consists of many characteristics and is an evolving process.  As nurse leaders we can participate in these changes, use our knowledge of national guidelines and governances to assist in exceptional results within our hospitals and facilities.

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