Man Power Planning in Nursing: How can Nurses Deliver Holistic Care if there is Lack of Staffing - Nursing Assessment Answers

Introduction

The need for an integrated and seamless service in healthcare industry is undeniable at any given point of time. Health and health services are intangible, where point of origin and point of consumption merges into each other making the need for a holistic approach towards the system an obvious one (Rosseter, 2012). To deliver a seamless service, an organization or a system will require sufficient manpower to pull off the task and also proper resource allocation and utilization to provide quality care. Nurses are the primary caregivers in health industry, bridging the gap between patient and healthcare delivery system. The need for sufficient nurses in a health care providing organization is imperative (Hunt, 2013).

Problem of Nursing Staff Shortage

Dr. Jeannie Cimiotti in his research in journal of American Infection Control (2012) has identified that shortage of nurses is affecting healthcare providing system at large all over the world. According to the “International Council of Nurses” shortage and misdistribution of nurses is a problem faced by many countries served by World Health Organization. Australia is also experiencing the difficulties in procuring and retaining sufficiently skilled, knowledgeable and professional nurses (Hunt, 2013). The hospitals in Australia are experiencing about 30% attrition rate per year. A survey conducted by “International Council of Nurses” (2013), nearly 55% nursing population is nearing the age of retirement. According to a survey conducted in 2007 by Dr. Christine Kovner, about 13% of fresh graduates of registered nurses exhibiting alarming rate of attrition-changing job within a year. Nurses in Australia has reported across the country, that they are working higher amount of overtime, while accurate shortage of nurse cannot be mapped due to inadequate and improper maintaining of data (Nursing Storage Fact Sheet, 2012).

Shortage of Nursing Staff and effect on Patient’s Health

Researchers have explained in various studies that shortage in nursing staffs can affect adversely on patient’s health. There is a dearth of nursing staff owing to management’s pressure on minimizing cost, and unavailability of skilled and efficient nurses (Howard, 2015).

In a study by Dr. Jeannie Cimiotti and colleagues revealed that rising patient to nurse ratio and nurse debilitation was directly proportional to rising infections in urinal tract and surgical sites. This study published in American Journal of Infection Control August 2012 issue and done on Pennsylvania hospitals, brought into picture that nurses were more prone to infections when she was given one more patient to handle than usual. The researchers thus concluded that in order to better the level of patient care and to also keep an eye on the well-being of the nurses, the patient load on nurses must be reduced (Rosseter, 2012).

Dr. Mary Blegen in a research stated that nursing staff recruitment is directly related in patient health outcome. Higher no of staffs recruited as nurses resulted in lowered number of deaths, reduced average length of stay and reduced hospital acquired infections. It can be said that quality of care can be compromised in a state where nurses are suffering from lack of manpower (Nursing Storage Fact Sheet, 2012).

In another study conducted by Dr. Needleman (2011), indicated that increased patient mortality rate is directly proportional to shortage of nursing staff. The situation is further complicated in critical care units. An understaffed critical or intensive care unit has mortality rate 6% higher than appropriately staffed units. In another research conducted on surgical care unit, Dr. Aiken (2010) has explained maintaining appropriate nurse-patient ratio significantly reduces patient’s mortality in surgical care unit patients (Storch, 2011).

According to Dr. Peter Buerhaus, registered nurses and chief nurses often complaints of not being able to spend required amount of time with patient, due to workload, fatigue and lack of manpower. Nursing staffs are not being able to perform quick diagnosis, maintain safety precautions, spending time with patient and his family and understand the underlying context, overall health and psychological status, or consult and collaborate with other health care providing team members to develop proper plan of care (Parahoo, 2015). These issues resulting in readmission, increased length of stay, deteriorated level of quality service, increased level of hospital acquired infections, and high level of patient dissatisfaction. Services are also getting affected in terms of promptness and efficient service in emergency rooms, and ambulatory set ups (Rosseter, 2012).

Manpower Planning in Nursing

Keeping in mind the criticality of nursing shortage in the healthcare scenario it can also be said that utilization of resource is also an important factor in dealing with the scenario. In the following sections it has been discussed how it is important to cater to the need of the patient without compromising quality of care in an understaffed situation. It has also been discussed further on strategies to prevent high attrition level, procuring enough numbers of efficient and skilled resources, and ways of retention (Hunt, 2013).

Nursing manpower planning is a complex process which involves understanding the healthcare providing atmosphere and the organizational capacity to procure manpower, in terms of budget and organizational policies. In the present discussion some popular theories have been brought into discussion to understand the staffs mix formulas (Gerrish & Lacey, 2013). Literature studies shed light on existing theories on manpower planning in nursing. The theories relevant in this discussion are: Professional judgment (Telford approach), Nurses per occupied bed (NPOB) or Top-down method, Acuity-quality (bottom-up), and Timed-task or Timed-activity method (Nursing Storage Fact Sheet, 2012).

The professional judgment method helps in calculating the required number of staffs in a particular sift and also total no of nurses required to manage the unit throughout the day and night . It is a useful method by which a simple calculation can be made for deciding how many nurses are required to manage a particular unit (Gastmans, 2013). A nurse per occupied bed method- is another popular theory by which nurses required for an occupied bed can be exacted. Acuity-quality method works for the units where patients and bed numbers fluctuate. Time –task/ activity method is little more complicated but an advanced one, as it takes into count the time of nursing interventions required (Storch, 2011).

Another two theories that can be discussed in the present context are theories that deal with nurses’ retention and reducing nurses’ attrition rate. Neuman Systems Model, developed by Betty Neuman, emphasizes on overall determinants to increase job satisfaction. It looks into aspects like person, environment, nursing and health (Nursing Storage Fact Sheet, 2012). It focuses on how the person responds to stress and manages stress while interacting with determinants like health, environment, profession etc. Neuman theory can be applied by the organization to assess the stress level of the nurses so that it can be coped with effective stress management techniques and prior adjustments can be made to retain the nurses. Kanter’s management theory focuses on empowerment of staffs to increase workplace satisfaction (Rosseter, 2012).

Employees should be provided with opportunity to be part of organizational goal, learn and grow. Employees tend to perform better when motivated and take control in organizational development.

Analysis of Theories & Recommendation

Analyzing the discussed theories several methods can be recommended to make effective and efficient utilization of nursing staffs even in an understaffed scenario.

The nurses need to understand the appropriate requirement of nurses per unit and accordingly document it to share the information with management. Proper documentation regarding shortage of staffs can help management identify the issue and accordingly make decisions regarding new recruitment (Howard, 2015).

Assessment of patients and patients need is another procedure where nursing department can get an idea so as to where to put which nurses. If a critical patient needs two nurses to manage him, one head nurse or experienced nurse and another trainee nurse can be clubbed together to make a team to provide the care (Chiarella, 2012).

Based on Timed-task or time activity method analysis, a chart can be prepared and nurses can be divided accordingly. Patients who are assessed for higher medical attention and needs can be assigned with more staffs and patients who need relatively less monitoring and attention can be assigned less nurse (Nursing Storage Fact Sheet, 2012).

It is important to identify the core activity of the nurses. The core activities can be assigned to expert nurses and the trainee or new nurses can be assigned with the other set of tasks (Faden & Beauchamp, 2014).

Arrangements with nursing schools can be made to give the students an exposure to work environment while studying. Students can be assigned with duties under supervision of experienced nurses and can be paid stipend. It will minimize the cost of a new recruitment and students will get better exposure to professional work environment (Parahoo, 2015).

Conclusion

The complexity of healthcare providing organizations demands a thorough analysis of the situation. Shortage of nursing process is a perennial problem in healthcare industry. Policy makers should emphasize on revising nursing education policy, and increase placement activities in forms of professional experience programs, internships etc. Organizations should map the required number of nurses and accordingly increase number of staffs. Nursing agencies can be contacted for part time recruitments (Rosseter, 2012). Healthcare delivery system also needs to be flexible and promote positive atmosphere, motivation to reduce job stress, and increase job satisfaction. Methods need to be applied to minimize nurses’ attrition and retain efficient manpower. An integrated approach by all stakeholders can help in minimizing the problem of manpower shortage and make better health outcomes. Healthcare delivery is a holistic approach and deserves support and cooperation from all walks –socio-economic-legal and political frameworks (Nursing Storage Fact Sheet, 2012).