The persistent shortage of nursing staff in hospitals poses the challenge on the belief and values of the profession. Inadequate staffing causes difficulties on nurses when carrying their ethical obligations to patients (Clarke, Donaldson, 2008). The effect of the shortage to the nurses is job dissatisfaction and emotional distress which in turn affect the quality of care they offer to the patients. In instances of shortages, the nurses fall in ethical dilemma traps of either taking care of their welfare or the patient’s needs. Nurses have the moral obligation of ensuring patients’ protection from any harm. When nurses are few, nurses tend to assign them the duty of care to many patients. In this case, the hospital’s goals become unrealistic since some patients require specialized care because of the nature of their illnesses (Clarke, Donaldson, 2008). For this paper, we explore on the ethical implications of inadequate staffing and the strategies an organization can take to assist in planning to avoid inadequate staffing.
The public expectation, the scope of practice, state laws and the licensure are all the ties that influence the legal implication of nursing practice as they provide them with the framework of duty (Shahriari, et.al 2013). All the patient population has the access right to health care. The nurses’ failure to exercise the required duty of care that a reasonable and prudent nurse would have done in such a similar situation or indulge in malpractice or professional negligence results to both ethical and legal violation. Nurses have both the legal and moral obligation to respond to the patient’s care request (Shahriari, et.al 2013). All these acts are likely to occur in hospitals where there is nurse shortage because of the high number of patients compared to the available nurses and this can affect how the nurses determine the type and level of the required intervention. In legal terms, the nurse can have the license reprimanded or lost.
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Ethical behavior among the nurses arises when they act in ways consistent with both their values and those held by their organizations. It is a continuous process since they have to study their beliefs and moral conduct and endeavor to live up to the provisions of the standards (Cerit, & Dinç, 2013). Each one of them has a personal moral code. Ethics is the basis for establishing moral obligation. Their ethical behavior dictates that they should be responsible for all what they are morally and legally responsible. They should identify and determine the importance of decisions, respect the right of others, communicate feelings openly and abide according to the personal values as well as the professional standards (Cerit, & Dinç, 2013). It is their obligation to show real apprehension and interest in the welfare of others.
Nursing is a determining factor of the quality of care offered to the patients and the nature of their outcomes (Clarke, Donaldson, 2008). Nurses remain a significant component of the health care delivery system and therefore, their staffing significantly affect the patients’ safety. They are at the center of hospital care provision because they form the largest proportion of patient care givers in the medical centers. High patient to nurse ratio increases workload which in turn affect the safety of the patients. Apart from that, subjecting nurses to heavy workloads increases their turnover (Carayon & Gurses, 2008). The categorization of the workloads occurs in four levels namely unit, job, patient, and situation. For instance, in a clinical unit, the nurses have to perform a lot of tasks in a particular shift. The type of unit and specialty will determine the amount of workload (Carayon & Gurses, 2008). Empirical evidence indicates that workloads that are heavy at the unit level among the nurses have an adverse impact on the outcomes of patients. A remedy suggestion to this issue is increasing the number of nurses on the unit to improve the patient care or lowering the number of patients under the care of each nurse (Carayon & Gurses, 2008).
Medical errors have significant effects on public health as they pose threats to the safety of the patients (La Pietra et.al 2005). The primary causes of these errors are understaffed nurses and overworked healthcare workers. Identifying medical errors and their causes is a significant milestone on the promotion of patient safety. Execution of medication orders falls in the realm of the nurses’ work and is an essential part of the treatment and care process. However, the risk of medication error remain high and thus hindering the preferred patients’ outcomes (La Pietra et.al 2005). One of the cited solutions to this problem is increasing the number of nurses and adjusting their workload burden. Some of the medical errors associated with nursing shortages include the following. Omission error can arise when the nurse fails to a medication dose before scheduling another one. They can give medication outside predetermined intervals. There is a likelihood of delivering greater or lesser amount of drug than the recommended for the patient’s condition (La Pietra et.al 2005). Other medical errors would be fragmented care, wrong drug preparation, and improper drug administration.
There is a realization that nurses are valuable sources of information necessary for decision making that entail ethical issues. However, in the course of the duties and responsibilities, there is reduced inter-professional communication which hinders exchange of opinions (Wilson-Barnett, 2017). The outcome of this kind of administration in hospitals frustrates and upsets nurses because their work is affected by the policies of others. Traditionally, the nurses have to follow the orders from the senior members initiated on routine basis curtailing their reasoning and intellectual skills (Wilson-Barnett, 2017). The changing nature of the nursing profession requires the desire to determine their role in the care delivery. Nurses, however, face ethical dilemmas when the number of patients increases relative to their number. On the other hand, it is their essential duty to accord patients care. They are left worried on how to deliver quality care to the patients, yet those in need are more than the available number of nurses.
Apart from the ethical dilemmas faced by the nurses, the hospitals to meet them. The number of patients is becoming more while at the same time the costs of hiring and keeping registered nurses are also high. Hiring more nurses means that it has to budget for the additional staffs because of the significant impact they have on the payroll. On the other hand, letting the number of patients outweigh the nurses will compromise on the quality accorded to them since some require more attention than others, yet all need nursing care. The implication of this is the workload at the clinical units.
There are several strategies the hospitals can undertake to plan and avoid inadequate staffing. Technology can help to match the particular patients with their specific nurses to improve their overall care. Through the application of the patient classification tools, one can determine the requirements for every patient to match them with the nurses who can meet their needs (Middleton, 2014). In this way, there can be an even distribution of work load between the nurses. It can also help in identifying the number of patients allocated to each nurse so that those having more patients can additional staff hired to assist them.
The hospitals can engage in open-shift management. Here, the management can post the unfilled shifts so that the nurses can sign on and contact the available shifts particular to their divisions for which they have adequate training (Meisel, 2010). In this way, the nurses will work only on the open shifts and thus eliminate over time. The program will give the nurses chances of identifying additional shifts so that they can increase their income. The program works with full-time and part time staff. In addition to that, the hospitals can use self-scheduling and needs-based staffing to ensure that patient acuity and that each unit has the proper amount of nurses (Meisel, 2010).
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The relevant authorities governing the conduct of hospitals as well as the nurses should offer training and educational programs to the management of the healthcare institutions to impart them with the knowledge on the need to have adequate staffs. Training programs should point out that the lower the nurse-patient ratio, the higher the quality of care each patient will get. Apart from that, understaffing causes a lot of work load and fatigue to the nurses and has the effect of lowering their performance.
In conclusion, even though the nurses have the ethical obligation of ensuring patient protection from harm and quality care delivery, inadequate staffing introduces obstacles in their tasks. The ethical dilemmas faced by the nurses have legal implications when they fail to act within the scope of their expectation. For instance, their failure to act within the recommended duty of care can have legal consequences even when the cause attributes to the shortage of nurses. It is, therefore, important for the management to recognize this need so that they can devise appropriate strategies that can end the understaffing.
- Cerit, B., & Dinç, L. (2013). Ethical decision-making and professional behaviour among nurses: a correlational study. Nursing ethics, 20(2), 200-212.
- Clarke SP, Donaldson NE (2008). Nurse Staffing and Patient Care Quality and Safety Chapter 25. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD).
- Carayon P, Gurses AP. (2008). Nursing Workload and Patient Safety—A Human Factors Engineering Perspective chapter 30. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD
- La Pietra, L., Calligaris, L., Molendini, L., Quattrin, R., & Brusaferro, S. (2005). Medical errors and clinical risk management: state of the art. Acta Otorhinolaryngologica Italica, 25(6), 339–346.
- Meisel, M. (2010). Four ideas to improve staff management. Health Management Technology.
- Middleton, J. (2014). “It’s time to end the understaffing scandals”. Nursing times, 110(9), 1-1.
- Shahriari, M., Mohammadi, E., Abbaszadeh, A., & Bahrami, M. (2013). Nursing ethical values and definitions: A literature review. Iranian Journal of Nursing and Midwifery Research, 18(1), 1–8.
- Wilson-Barnett, J. (2017). Ethical dilemmas in nursing. Journal of medical ethics (12). 123-6.