Staffing Challenges in Long Term Care Nursing and Solutions
The purpose of this report is to analyze and discuss the staffing challenges that exist in long term care nursing and the implications it has on patient care. The report presents a brief on the problem first and then presents some of the possible solutions that could be undertaken by the administrators of health care institutions that are dealing with actual nursing staff shortages.
The Nursing profession is one that has been known amongst the healthcare profession, to experience several challenges. Staffing challenges have been noted to be one of the primary health care challenges with respect to the nursing profession. These challenges have been known to not only affect the nurses, but other health care professionals who work with nurses on a daily basis.
This could also affect the quality of care they tend to provide for their patients. The purpose of this report is to discuss how staffing issues in nursing (with emphasis on long term care) has implications on patient care. The main purpose of this paper is to analyze and present solutions and recommendations for the issue.
The factors such as increasing staffing by means of including a more widened demographic for nursing training and more are presented using the support of existing literature research. These recommendations can be made use of administration of health care facilities to improve with respect to their staffing shortage problems.
Shortage of Registered Nurses (RNs) and subsequent degradation in quality of patient care has been the most critical issue that the whole medical community across United States is facing in recent years. Nurses play a significant role in patient’s recuperation right from the admission to hospital to his discharge and later at home for rehabilitation till he is capable of looking after himself.
But the current staffing issues of nurses could result in a complete collapse of healthcare system. Therefore this report is set to review staffing challenges in long term nursing, its causes and consequences on the field of medicine and the suggested possible solutions in a more holistic way. A myriad of elements are considered and the solution is framed with these elements. This report also recommends few strategies and a feasible plan of action for successfully overcoming the challenge.
Issue Analysis
The sharp decline in mortality rates and increase in life expectancy has led to a greater proportion of old population in 20th century. This has led to more emphasis on aged care. The baby boomers are now in their retirement ages fast approaching the time where they might require more health care. Knickman, & Snell, 2002, assess how there will be challenges in caring for the baby boomer generation as they crossing their ages of 60.
In a series of analyses that was conducted with respect to types of challenges that would be faced, it was seen that the baby boomer generation will require much long terms care and this would lead to an economic burden for the state and also the health care system.
In addition there has also been noted that the incidences of different diseases have increased, epidemic of various diseases and increase in accidents have ultimately escalated demand for RNs. Diseases related to obesity and cardiovascular problems are on the high (Van Gaal,et al, 2006).
Diseases such as this lead to the increase in the number of people that require long term care. The proportion of aged people requiring long term care is still higher, yet the number of other demographics that require long term care has also increased contributing to the nursing shortage scenario.
Insufficient number of graduate nursing programs and faculty, inadequate classroom space, less developed clinical sites and preceptors, and budget limitations put restrictions on nursing program enrollments, all of which can contribute to staffing challenges within the health sector.
This generates very small number of qualified RNs that fit into the requirement of highly sensitive cases (Drury, Francis & Chapman, 2009). The problem of there being insufficient nursing programs directly leads to lesser students graduating from the program.
However it is also noticed that students might be reluctant to take up nursing programs like they did before. Also the ones that do take up nursing education might also end in giving it up because of the stress levels that are generated in this work. Extra working hours, low wages, inability to devote time for personal life and extended workload impose more stress on RNs.
Lack of job satisfaction and depreciation of job status further discourage them to continue in nursing profession (Peterson, 2001). Crash of revenues directly impacts into slashing the nursing staff in hospitals which makes this nursing job very unstable. This deficiency of certified RNs add patient complications, medication errors, death rates, safety problems, longer hospital stays, nurse fatigue and burnout and unpleasant experience for both patient and nurses (Wright & Bretthauer, 2010).
Staffing challenges is not a problem in current times alone. The nursing shortage has been a problem for a longer time now. As of the 1990’s it was noticed that the nursing shortage was existent in the country as with many other global nations. Nursing positions were cut in the countries like the United States because health care expenditure was increasing with respect to managed care.
Public and private insurance reimbursement was also at an all time low and this lead to financial difficulties for hospitals which reduced the number of nurse practitioner working with them. In addition to this problem it was also noticed that most of the hospital administrators did not consider the nursing profession in its actual light.
They did not understand the value of the nursing professional and did much restructuring to improve finances that were highly focused on decreasing the number of nurses employed with the organization.
This asymmetry in power was seen to have made much of the nurses to remain underpowered (McVicar, 2003). Nurses that went out of their professions moved on to become housewives and hence lost the training and expertise that made them nurses or moved onto other professions in different fields. With understaffing, the work performed by nurses was done by assistive personnel. The existing nurses could not work with the short staffing. A National Survey that was conducted on nurses in the year 2005 indicates that more than a million of the U.S. registered nurses chose to leave their jobs either because of the instability of their positions or because they could not perfume as was required because of understaffing at their place (The Truth about Nursing, 2007).
In current times, social issues also contribute to nursing shortage. The nursing profession is still viewed as a gendered profession meaning the profession is still a female dominated profession. Women are seen as natural caregivers in socio-cultural contexts and men are quite reluctant to enter nursing professions.
Research indicates that men might face a social stigma when they want to enter nursing professions. In countries such as the United States only an approximate 6 percent of the population is seen to be in the nursing profession. With the current workforce rapidly aging, soon the nursing shortage problem will exacerbate if the current shortage is not filled with a younger workforce.
The workforce will also need training from senior peers and for the nurses to be trained in a qualitative manner, it is necessary that the shortage problem be addressed and training commence as soon as possible under existing senior nurses.
Solutions to Staffing Challenges
Some of the problems such as the aging of baby boomers that puts them in the situation where they need more aged care cannot be resolved. So these issues contributing to the nursing shortage cannot be handled, yet there is significant other issues as pointed out that could be handled well.
Primarily it has been noted that the number of nursing school graduates have become lesser. Adequate funds should be arranged to encourage graduate schools to improvise nursing programs by facilitating necessary infrastructure and services, and appointing experienced teaching faculty.
A special attention should be provided to verify the competency of undergraduate as well as the graduate curriculum to produce skilled and knowledgeable RNs in future (Peterson, 2001). This solution is the best long term solution, as it will ensure that there are more nurse practitioners in future. However it is necessary that this solution be implemented by considering the implications of implementation.
For instance, in the issues section, it was pointed out that as early as in the 1990’s the problems of nursing shortage was seen to be created by administrators who did not understand the value of the profession. They created budget cuts and staff cuts that led to job loss for nurses.
The mindset of health care administrators needs to be changed. The power asymmetrical has to be set right. Only then future nursing practitioners will have sustained profession. Where a student question how sustainable their future is as a nursing practitioner then they might be reluctant to enter the profession itself.
RNs can postpone their retirement age which would allow them to work longer and let the new staff learn from their valuable experiences. To eliminate imbalance after their retirement, mix of young as well as matured RNs should be recruited to impart diversity (Drury, Francis & Chapman, 2009). In this way the raining for the younger nursing practitioners could be more qualitative.
An optimal staffing framework should be constructed to ensure safe and quality patient-care, and fulfillment of organization’s financial constraints. It would guarantee better salary, stability, job satisfaction and pressure-free working conditions for staff. Coordinated scheduling and planning can reduce overtime, undesirable working hours and also the labor costs with great margins (Wright & Bretthauer, 2010).
Community should be encouraged to play their part in long term care. Community, meaning the family, friends, local volunteers and more should be able to assist in long term care and this would help in managing the nursing shortage problem till a long term solution is implemented.
Recommended Action
To implement the possible solutions effectively, the administration as well as the NGOs should contribute monetarily to ease the primary need of financial expenditure. Every state administration should accumulate data of their respective patient population that need unique nursing care such as old age group, incurable disease, contagious patients etc.
By comparing it with the availability of nursing staff and resources, an optimal and flexible staffing approach should be developed for at least next 5 years and accordingly the funds should be allocated wherever required (Wright & Bretthauer, 2010). Depending upon the need, the RN staff should be imported or exported between the states by mutual agreement (Peterson, 2001). It would provide correct number of nursing staff with mixture of correct qualification, sufficient experience and appropriate skill.
Working on the nursing staff shortage problem as of present, surveys have been conducted to understand why the shortage is an actual ongoing problem for nursing practitioners (from the Progress Report). The survey itself was quite problematic as most of the hospital personnel were reluctant to give answers to the surveys.
A major attitudinal change is hence required here. Secondly (as indicated in the Progress report) there are more future accomplishments to be completed. Some of the issues that one would expect to encounter is when coming up with the incentives to encourage low grade nurses and nursing assistants to get back to school or training to become more quality workers. This form of incentive negotiation has to be done with the administrators.
The nursing practitioners also have to be inspired with long term vision so they go back to retrain and they also have to be inspired by the institution so that they would be loyal enough to return.
Secondly, it is necessary to include benefits program for the nurse practitioners. Long term career training plans must be made, and by working with the human resources motivational reimbursement packages and more have to be created. Where possible it is also necessary to offer them other forms of job security.
Conclusion
Nursing is the backbone of healthcare industry. Though it is affected by staffing difficulties, government of all the states in America should work in collaboration to assess the current situation and outcomes of implemented actions. It would enable them to decide upon the best solution apt for the longevity of the business.
References
Drury, V., Francis, K. & Chapman, Y. (2009). Where Have All the Young Ones Gone: Implications for the Nursing Workforce. Web. The Online Journal of Issues in Nursing, 14 (1).
Fox, R. L., & Abrahamson, K. (2009, October). A critical examination of the US nursing shortage: Contributing factors, public policy implications. In Nursing Forum (Vol. 44, No. 4, pp. 235-244). Blackwell Publishing Inc.
Knickman, J. R., & Snell, E. K. (2002). The 2030 problem: caring for aging baby boomers. Health services research, 37(4), 849-884.
McVicar, A. (2003). Workplace stress in nursing: a literature review. Journal of advanced nursing, 44(6), 633-642.
Peterson, C. (2001). Nursing Shortage: Not a Simple Problem – No Easy Answers. Web. The Online Journal of Issues in Nursing, 6 (1).
The Truth About Nursing. (2007). Nursing Shortage.
Van Gaal, L. F., Mertens, I. L., & Christophe, E. (2006). Mechanisms linking obesity with cardiovascular disease. Nature, 444(7121), 875-880.
Wright, D. & Bretthauer, K. (2010). Strategies for Addressing the Nursing Shortage: Coordinated Decision Making and Workforce Flexibility. Decision Sciences, 41 (2): 375- 400.
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Question: How have you handled staffing challenges in long term care nursing? Feel free to leave a comment below
Incredibly engaging post – your insights are remarkable!