Staffing Issues for the Emergency Room in Hospitals in the United States
Today, the delivery of health care services has become a complex task for nurses as the practice requires coordination of efforts between many health care professionals. In the United States, each person working as a healthcare staff plays a major role in the success of the services delivery with registered nurses (RNs) viewed as the crucial group of personnel allied to offering the medical service to the community members. According to Buerhaus et al. (2007), insufficient supply of essential nursing workforces, such as the RNs can be a stressor for hospitals because it can make healthcare settings struggle in meeting their goals as well as the health care demand from the public members. This means that whenever there are inadequate numbers of nurses in the hospitals, the risk for adverse outcomes relating to patients will occur, especially in the emergency rooms where sustainability of the care service is required to avoid increased mortality rates.
Liang et al. (2012) posit that in the U.S, the problem of the nursing shortage is projected to escalate, with statistics showing that by 2025, the shortage of nurses in the American care setting will grow to 260,000, which will, in turn, affect the life of patients requiring emergency care service. Conversely, due to lack of adequate numbers of clinicians in the American hospitals, patients in ICU, operation room (OR), and the one who needs critical care services are exposed to the risk of losing their lives or even contracting more complexities throughout the treatment process. Carlson (2017) writes that the American Nurses Association (ANA) proposes that for hospitals to meet the needs of the American people, nurse-patient ratio, and the overall staffing plans, they should establish an adjustable number of registered nurses, which is essential to the treatment of patients in the emergency rooms. Therefore, this project will focus on analyzing the staffing issues in relation to the employment of medical employees in the U.S. who are set to attend for the patient in the emergency room. The research will also look at the shortage of the RNs in the US hospitals, with the primary focus being on the nurse-patient-ratios within the care systems.
Investigation of the Problem
In the section, the project will heed on assessing the American Nurses Association (ANA), as the group recognized to promote healthcare system in the U.S. and maintaining that staffing in the hospital enterprises is done according to the legislations established to make staffing the U.S. hospitals effective. In an effort to understand the perspective of ANA on the issue of staffing shortage in the hospital’s emergency department, the literature on the similar subject will be used. The American Nurse Association (ANA) works with other groups mandated to improve the staffing process in the American hospitals aimed at ensuring that hospitals exercise sound staffing plans (CNA HealthPro, 2017). This role is primarily meant to ensure that the number of physicians employed meets the number of patients seeking medical attention. Further, Patton et al. (2015) state that the nursing staffing issue has been persistent in the U.S., but the American Nurse Association (ANA) collaborates with other associations to represent the interest of the nurses and enhancing that the clinicians working in the hospitals are adequate and enough. Moreover, Hughes (2008) opines ANA takes the responsibility of standardizing the staffing programs and ensuring that the staffing activities reflect the outcomes needed as well as focus on quality improvement within the system.
Current Data on the Issue of Staffing in hospital’s Emergency Rooms
Patton, Zalon, and Ludwick (2015) point out that in the US, there are more than 3.1 million RNs and each hospital executes safe nurse staffing as one of the federal policies set by ANA to enhance the success of the healthcare affairs and solving problems related to nurse-patient-ratios. Similarly, Cherry and Jacob (2016) note that based on a survey that involved 220,000 RNs in over 550 hospitals, 70% of the nurses claimed that 54% of the clinical officers in the emergency rooms do not have sufficient time to attend to the need of the patients in the emergency rooms. The ANA reported that 54% of the nurses in the emergency units spend insufficient time with patients, while 43% of the nurses in the department work extra hours to meet the needs of the sick people or individuals requiring immediate medical attention (CNA HealthPro, 2017).
One of the reasons that are causing the problem of nursing staffing in the US hospitals is the current employment strategy. May, Bazzoli, and Gerland (2006) found that a large number of nurses are employed on a temporary basis, which makes them sign short-term contracts and work on individual shifts, hence affecting the number of staffs supposed to in the emergency rooms. The other reason causing the shortage of nurses in the emergency rooms in hospitals is the aspect of increased of care services demand due to aging population. For instance, Keenan and Kennedy, (2010) reports that in the US, the population is set to grow by 18% between the year 2000 and 2020, which means that the need to attend to patients in the emergency rooms will escalate comprehensively. Preference to other careers is also contributing to the shortage of the nursing staff working in emergency units (Keenan & Kennedy, 2010). As a result, this trend has made the number of nurses working in hospitals to be less than it is should be to meet the demand.
Solution to the Problem
Indeed, to manage and control the issue of nurse staffing in the US, healthcare organizations should consider changing the manner in which RNs are trained, especially the additional training offered to nurses to enable them respond to the evolution of the healthcare setting (Keenan & Kennedy, 2010). It will be justifiable to use this method in addressing the shortage of RNs required in the emergency department since the efficient training of the RNs will make nurses working in the emergency department become well prepared for new challenges and understand why it is important to work permanently in the emergency delivery unit. In addition, in this project, it is suggested that hospitals can apply financial strategies to deal with the problem of staffing issues in the emergency unit, especially using financial incentives to tie nurses to their job. Evidently, when RNs in the emergency sector are given competitive salaries and referral bonuses, a number of staffs will embrace retention and become committed to work in the emergency department, which will enhance that the number of nurses in the emergency department is sufficient (May, Bazzoli, & Gerland, 2006).
Resources to Implement the Solution
In the implementation of the solution recommended for this project, devoting necessary resources will be essential in enhancing the success of the project and consistency when implemented. While funding in the healthcare system has been an issue of concern, for care centers to ensure that the problem of inadequate nurses does not become persistent, proper funding is necessary in the improvement of efficiency in the staffing department (World Health Organization, 2017). Thus, in this proposal, to apply the suggested plan successfully, hospitals should consider increasing the wages and salaries of registered nurses in the emergency unit. In turn, this will affect the recruitment processes positively and enhance retention of outstanding RNs who are already in the workforce. For example, care institution can improve wage and salary increment by paying nurses for their overtime tasks, bonuses, paying for vacations and holidays, as well as having a severance wage program that is sustainable (McHugh & Ma, 2014). Consequently, this will make the staffing unit in many hospitals reflect the need of the patients in critical conditions. Moreover, there is a need to increase the training of the RNs and ensuring that they are up-to-date with trends and skills required in the field. The training will need funding as well as material resources such as books, pamphlets, and other learning resources. Lastly, the organization may need to employ a specialist to oversee the training process as well as assess skills that the RNs have.
Cost Benefit Analysis
In this context, the cost benefit analysis (CBA) will be used to calculate the benefit of the suggested solution in comparison to the amount of the money that will be used to execute the plan. Therefore, this section heed on conducting the CBA for the training plan, determining the cost of the practice, and scheming the benefit of the program in reference to the cost that will be applied will be the key activities. In the evaluation of the cost of training for nurses, it is proposed that the cost to be incurred for this practice will be categorized under direct cost elements. The cost of training intends to be direct because to carry out the practice, hospital equipment and resources will are applied (Siddharthan et al., 2005). In this case, the practice of training the RNs will make the hospitals to increase the payment fee for both the nurses and the trainers. At the same time, the cost of the training program will be defined with regard to the number of the RNs taking the development course and the days of the whole process (Nielsen, 2003). In essence, the facility will spend $200 in training each RN in for three months aimed at increasing their skills to work and commit themselves in the emergency unit. In addition, 20 attendees will take the course, which means that the total cost of training for the entire period will be $4,000. Although the expense of the program will affect the resources in the hospitals, the practice of training will increase productivity and ensure that the rate of turnover is minimized.
Moreover, since the program expects to increase the efficiency of the RNs, extrinsic motivation through a 5% increase in salary, applicable bonuses, and promotions will be necessary. The facility will focus on including the aforementioned changes in one to two years as it assesses whether the increased training has been beneficial to the organization. While the above costs will mean that the organization has to make a supplementary budget or find means to acquire the extra funds, this project will lead to increased service delivery for patients, which is a primary objective for the organization. The training will also create a sense of teamwork among employees and also help improve their skills in the field. As such, with the increase in salaries, the organization will improve on both intrinsic and extrinsic motivation.
Timeline Implementation
The researcher plans to use one year to implement the proposed plans, whereby the already hired RNs will undertake more training with regards to the changes that may occur in the line of their duty in the emergency room. The training program will start by a short survey, interviews, and discussions with RNs and other stakeholders on challenges facing the emergency department and highlight the importance of the suggested solutions. Two weeks to one month will be enough to provide a report and include all stakeholders. The next three months will include a series of training for RNs with a minimum of 10 hours a week. The next two months will include an assessment of whether the RNs have benefited in the program and whether it is effective in improving service delivery. A follow-up assessment will be done after six months and two others within the projected two years. RNs trained in the program will be instrumental in training other RNs in the emergency department as well as those in other departments within this period. Upon completing the training program, the RNs working in the emergency department will be given salary bonuses as well as satisfactory wage increase to motivate them to become retained working for one employer for a longer time.
Stakeholders Involved in the Implementation of the Plan
In the process to implement the solution meant to address the problem proposed in this project, the researcher will involve the following stakeholders.
- Nurses working in the emergency unit such as ICU and operating room (OR)
- Physicians attending to patients in emergency rooms
Importance of Each Stakeholder
For the medical professionals who will be involved in the training program, the researcher will use their knowledge and perspective to plan on how to enhance the training program. Since the plan is to use training initiative to grow and develop nurses working in the ICU and OR, incorporation with the doctors will be substantial for the project planner because doctors will give the planner ideas that will expand the knowledge of the nurses and make them motivated to continue working in the emergency rooms. The nurses will also be relevant to the execution of training program since when involved in the application of the plan, hospitals will see the need for further training for RNs in all units within the care setting.
Engaging with the Stakeholders
In this case, the researcher will focus on making the proposed program meaningful and useful for every stakeholder who will participate in the practice. Importantly, engaging with the stakeholders will be critical, as the researcher will update the skills of the staffs who are already doing their roles in the ICU and OR units intensively. Hence, the planner will get feedback from the stakeholders to engage with them through collaborative programs, in which both the RNs taking the course and doctors assisting the researcher will work together to solve the problem at hand. The feedback will be based on the context of whether the program is satisfactory, helpful, and insightful.
Working with the Stakeholders
May et al. (2006) assert that hospitals using short-term training practices for the workforce with the aim of creating commitment and retention can execute the plan using different strategies. However, working as partners with the nurses taking the program is efficient, and it will ensure that clinicians benefit from the program as planned. Therefore, to make the program successful, the investigator will first focus on making the activity structured. As such, it will be critical to arrange nurses into small groups according to the flexibility of the members who will participate in the implementation of the project and then use the available resources to make the plan actionable.
Implementation of the Solution
To implement the solution set in this project, the investigator proposes that it will be worthwhile to use in-service training, as a method that hospitals can use to enable RNs to execute their duties efficiently. According to Norushe et al. (2004), in-serving training is an integral activity in the nursing system, as the practice is part of the continuing education required by the RNs to meet the needs of the care system. Hence, to implement the solution, hospital supervisors and instructors will plan to employ in-service training programs and encourage the participation and involvement of the RNs working in the hospitals. The inclusion of the important topic in practice will be significant, especially the subject that will be based on the operational problem within the healthcare unit where nurses require new skills and additional knowledge. Typically, to make the in-service program more didactic and supportive to RNs, it will be imperative to use printed materials in the implementation task. As such, when the educators in the hospitals integrate the use of printed materials and interactive method to disseminate the plan in this project, the practice will exhibit high beneficial impacts to the care systems and RNs taking the course.
Evaluation of the Proposed Solution
In the process of evaluating the recommended solution, the investigator will focus on assessing the procedure of implementing the solution, examining the objective of the project, and determining the outcomes of the project. Throughout the evaluation process, the researcher will identify the capabilities of the project as well as the impact of the solution toward the care system. The project leader will review the outcome of the care services after the implementation of the recommended plan. If the program has led to better patient outcomes, improvement in service delivery, and motivation as well as better skills for employees, it will be evidence for the researcher to conclude that the projected solution has been successful and hospitals will be in a good position to retain a significant number of nurses working in the emergency department. With the consideration of the organizations, impact, and outcome of the project, the investigator will use the information to determine the validity and reliability of the proposed solution.
Roles Fulfilled during the Research
- Scientist- As a scientist, I carried out different tasks that would fulfill nursing science through training with the goal of making the health care system practices useful and efficient for ICU and OR physicians. For example, I believe that as a scientist, I can use the knowledge that I acquired of scientific concepts that can be used to make healthcare associated decisions for effectiveness in the care system.
- Detective- Here, I fulfilled my role as a detective by applying personal clinical imagination together with my nursing knowledge to propose a change that will make healthcare systems in the U.S. control the problem related to nursing staffing. In essence, I feel that as a detective I can use my skills to monitor healthcare practices and pick up the most outstanding activities in the process of delivering healthcare services.
- Manager of the healing environment – Finally, based on this investigation, I believe that I have fulfilled my role as a manager of healing the environment, since I suggested a plan that will rebuild the entire society, hence bringing sustainability within the community, and making the environment safer for every member of the public. As such, being a manager means that I will use my capabilities to direct and implement practices that will change the environment and help the community to administer their environment inside and outside the healthcare system.
Recommendations for Nursing Patient Ratio
In the quest to recommend for the nurse-patient ratio in the emergency rooms, it will be essential to consider factors like the level of staffing, facilities available in the hospital, and factors that influence the delivery of care services. Thus, based on the need of the patients with critical care needs, intensive care unit (ICU), or patients requiring resuscitation in the emergency rooms, it is suggested that the nurse-patient ratio should be one-to-one (1:1). For the patient in the emergency operation room but they are being treated due to complications relating to pregnancy and unstable neonates, the nurse-patient ratio should be one-to-three (1:3). This will ensure that RNs are not assigned to the emergency rooms forcefully, and each nurse is working based their qualification, knowledge, and skills.
References
Buerhaus, P. I., Donelan, K., Ulrich, B. T., Norman, L., DesRoches, C., & Dittus, R. (2007). Impact of the nurse shortage on hospital patient care: Comparative perspectives. Health Affairs, 26(3), 853-862.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.
CNA HealthPro, (2017). Safe nurse staffing. Retrieved from: http://www.nso.com/Documents/pdfs/Newsletters/Safe_Nurse_Staffing_ _Looking_Beyond_the_Raw_Numbers_2009-4.pdf
Hughes, R., (2008). Patient safety and quality: An evidence-based handbook for nurses (Vol. 3). Rockville, MD: Agency for Healthcare Research and Quality.
Keenan, P., & Kennedy, J. F. (2010). The nursing workforce shortage: causes, consequences, proposed solutions. Issue Brief (Commonwealth Fund), (619), 1-8.
Liang, Y. W., Chen, W. Y., Lee, J. L., & Huang, L. C. (2012). Nurse staffing, direct nursing care hours and patient mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study. BMC health services research, 12(1), 44-51.
May, J. H., Bazzoli, G. J., & Gerland, A. M. (2006). Hospitals’ responses to nurse staffing shortages. Health Affairs, 25(4), 316-323.
World Health Organization, (2017). Using available resources in the most efficient and equitable way. Retrieved from: http://www.who.int/health_financing/strategy/equity_efficiency/en/
McHugh, M. D., & Ma, C. (2014). Wage, work environment, and staffing: effects on nurse outcomes. Policy, Politics, & Nursing Practice, 15(3-4), 72-80.
Siddharthan, K., Nelson, A., Tiesman, H., & Chen, F. (2005). Cost effectiveness of a multifaceted program for safe patient handling. Advances in Patient Safety, 3, 347-348.
Norushe, T. F., Van Rooyen, D., & Strumpher, J. (2004). In-service education and training as experienced by registered nurses. Curationis, 27(4), 63-72.
Nielsen, L. (2003). A cost-benefit analysis of training nurses for extended roles. Nursing times, 99(28), 34-37.
Carlson, K. (2017, Feb 23). Nurse-patient ratios and safe staffing: Why you should care. Retrieved from: http://nurse.org/articles/nurse-patient-ratios-and-safe-staffing/
Patton, R. M., Zalon, M. L., & Ludwick, R., (2015). Nurses making policy: From bedside to boardroom. Journal of Nursing Regulation, 6(2), 60-69.
