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

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.

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.

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).

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.

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.

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.

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.


            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).

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 (, 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?

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).

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.

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

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).

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).

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.


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.

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.

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.

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).

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.

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).

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.”

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.

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.

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.

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.

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.

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.

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.

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.

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.

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