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The Issue of Nurse Shortage

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Nurses are a vital component of the health workforce. They do more than care for ill patients, they are a technical expert, an educator, a counselor and many more. However, they remain on the long-term skills shortage list in New Zealand. This assignment will investigate the issues regarding the shortages in the healthcare workforce and its impact on the nursing profession. The quality of care the nurses perform on patients impacts their recovery and health outcomes. However, there has been a clear trend of shortages amongst nurses and as a result, nurses face challenges in delivering satisfactory care to their patients. Factors such as increased workload, altered nurse to patient ratio and missed cares are one of the consequences of the shortage crisis that reduces the quality of patient care.

A factor that contributes to the shortage of nurses is the difficulty of recruitment amongst young people. In a recent study, Pool (2012) takes into account that to enhance recruitment and retention of nursing, young people must first focus on enhancing the social value of the nursing profession. In this study, a group of young students were asked about their opinions towards nursing. The research highlights that nursing stereotypes were one of the influencing factors on why young people are not choosing nursing as a career. One participant identified the nurse’s role by the tasks she perceived nurses do. She quotes: “it’s [nursing] just like doctors but doctors are more qualified. They [nurses] do stuff with people. I don’t know … they carry around the booklet or they help the doctors; the doctor’s right hand.” The research highlights that this mindset in which young people viewed nursing as inferior to doctors, is consistent with many other studies. In addition, the participants conveyed that their inclination towards a nursing career is influenced by the media. The nursing profession rarely appears in the media as they were cited only “4% of the time out of the 2,000 health-related articles from 16 publications.” Their lack of exposure in the media has negatively impacted the profession as they are not seen as experts or as key leaders, and therefore they are not good sources for the media. For that reason, nursing as a career choice was invisible to these young participants because of the absence of a positive nursing role portrayed in the media. The difficulty of recruiting young people into nursing schools plays a huge role in why there is a shortage of nurses.

An additional factor and consequence that contributes to the shortages of nurses in New Zealand is the ageing population. As the population survives longer, the need for health care services such as registered nurses, increase. Evidently – within 10 years- there is a likelihood of a 75% increase in demand for aged care caregivers and nurses, due to an estimated 20,000 people needing residential aged care facilities. With the difficulty of recruiting young people into the workforce, the aged care nursing profession faces a crisis.

Due to the shortages the nursing profession faces, nurses experience an increase in workloads. As a result, this work intensification induces fatigue amongst nurses, thereby compromising patient safety. An article written by the ‘Nursing Praxis in New Zealand’ found that nearly 1/3 of NZ nurses reported increased involvement in non-nursing clinical tasks. Almost 2/3 of NZ respondents reported an increase in clerical and administrative duties, and 40% reported that the amount of time spent on their medical role had increased in the last 12 months. On top of their long shifts and assigned roles, it is evident that many nurses perform excess work which leads them to ‘burnout.’ More nurses are experiencing burnout due to their expanding roles which have consequential effects on their delivery of care, thereby compromising patient safety. High rates of burnout have major implications for the quality of care being provided to patients and consequently patient outcome. An example of the effects of nursing fatigue can be seen in an infamous case in 2007, in which a nurse in Wisconsin accidentally killed a patient by giving an intravenous bupivacaine intended for an epidural administration which had not been ordered. According to the case, “the nurse had worked her regular eight-hour shift and volunteered to work an extra shift that same day. Scheduled for a 7 a.m. shift on July 5, she slept at the hospital at the end of the two shifts”. In summary, as samples show, the rates of burnout our nurses face due to their increased workload is a consequence of the shortage crisis. Nurse fatigue negatively impacts the quality of patient care as they have the most intimate contact with their patients, therefore, fatigue-related errors can start a chain of improper patient care which can be fatal.

Due to understaffing and an increasing number of patients admitted to hospitals, nurses to a patient ratio is negatively altered. This shortage poses a threat to patient safety as it increases error, morbidity and mortality rates. According to a thesis written about patient safety, a medical nurse – in a New Zealand hospital- claimed that the ratio of nurse to patient has changed from 1:4 to 1:7. This unbalanced ratio can be very fatiguing to a nurse who can impair their delivery of care to patients. The thesis highlights an important point in which the risk of patient falls increases due to understaffing amongst nurses. Often, patient falls can be preventable but it is a challenge nurses face due to their lack of numbers, therefore not all patients are rigorously monitored. One case involved a patient with dementia who was placed in a room that was not easily visible from the nurses’ station. The ward was short-staffed and the nurses were “running frantically.” The patient fell and broke a hip when walking to the toilets. At that time, no nurses were around. Every so often, short staffing was aggravated by absenteeism due to illness. As fewer nurses are in contact with more patients, there is an increased risk of spreading infections and other illnesses which comprises patient safety as well as the nursing profession. The author highlights that on one occasion, 26 nurses had called in sick but because of shortages, only 7 could be replaced. A study found that each additional patient per nurse was associated with a 7% increase in mortality and failure-to-rescue rates for the patients, a 23% increase in the odds of burnout and a 15% increase in the odds of job dissatisfaction for the nurses. The study concludes that the impact of higher numbers of registered nurses was affiliated with better patient care and outcomes. Therefore, a good supply of nurses in the workforce is likely to deliver adequate patient care.

As a result of insufficient staff ratios, nurses may prioritise certain aspects of care, with some being less important than others, resulting in some nursing cares being delayed or missed. Missed nursing care is generally defined as any aspect of required patient care that is excluded or delayed. The quality of care nurses deliver is of utmost importance in the patient outcome. It is highly likely that when there are not enough staff members available, a nurse may not be able to complete all the care required for patients. Hence, there are notable impacts on patient outcomes such as medication errors, pressure ulcers and patient falls as previously highlighted. A thesis written by Conelis Teekman found that nursing assessment documentation was not always completed and hardly re-looked at. It was customary for parts of the assessment form to be completed without the consultation of the patient. This could be detrimental on patient safety Moreover; Teekman established that although some patients’ basic needs were not met – such as showering or not being out of bed- it did not mean that care was being overlooked but rather “cancelled because in the bigger picture of keeping patients alive”.

To conclude the essay, the shortage of nurses has many consequential effects on the profession such as burnouts, declined nurse to patient ratio and missed nursing cares. These factors have a significant influence on the quality of care nurses deliver to their patients. One of the key causes of nursing shortages is the difficulty of recruitment, which is easily avoidable. However, New Zealand’s ageing population is largely unavoidable, therefore aged care nurses are in high demand. As a result of a lack of nurses and other healthcare professionals in the workforce, nurses are taking on expanded roles and therefore, increasing their workload. As a consequence, they are overcome with fatigue, thereby increasing the chances of errors in their delivery of care. Since there is a lack of nurses to take care of patients, prioritizing becomes a problem. Often, care is not completed fully or to an adequate level due to a lack of staff available, resulting in the reduced quality of patient care. 

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