For any Heath care system to succeed, it is very important that the management focuses on the expertise of nurses. The hospitals today have lost understanding of what is essential to ensure best outcomes. Nurses are not included in decision-making, have little local authority, are penalized for identifying factors that lead to poor care and cannot claim excellent team relationships. They are looked down upon by Doctors and Management. The Management seems to ignore the health workforce and the role nurses play in delivering high quality care. Nurses are the biggest chunk of the workforce and accounts for almost 80% contact between patients and providers. They are the ones who have the right training to highlight needs from a treatment perspective apart from the providers. (Friese 2015)
As Dr. Kickbush rightly said, “Investing in nurses will improve services as well as bolster health promotion and diseases prevention- both vital levers in the heavy lift of delivering universal healthcare”. He mentioned that nurses over the years have been underutilized and under-resourced. Management should realize that the huge nursing dividend is the key to delivering the promise of health for all. The major issues nurses face these days include poor compensation, workplace violence, long working hours, short staffing etc.
To address these issues, below is a framework that may be adopted by decision makers and management to address the above issues.
• Nurses should be included in decision making process. They play an important role in treating a patient. Any decisions regarding the patient of the clinic as a whole should also be discussed with the nurses.
• Better compensation and rewards – There should be improvement in the pay scale of nurses. Various reward schemes should be introduced at intervals to boost enthusiasm of nurses.
• Hygiene of nurses –Focus should be given on inducing hygiene programs for nurses. They are the ones who stay with the patients for most times. It is very important for them to maintain cleanliness and proper hygiene so that no sort of germs are passed on to patients. Moreover they are the ones who interact with the lower levels of society. They can impart knowledge to their community and help prevent epidemics.
• Adequate Staffing – There should be adequate hiring of nurses. Under staffing threatens patent health and safety and results in greater complexities. Furthermore, inadequate staffing can hinder the efforts of nurses to carry out care processes. (Davila and Y.A. 2019)
• Reduce working hours – Long working hours lead to fatigue which could further lead to medical mistakes. Nurses should be called in shifts instead. With this implementation, risks of mistakes decrease. Even the patient dissatisfaction level shall decrease. A 2014 study found that nurses impaired by loss of sleep, fatigue, tiredness and inability to recover between shifts are more likely to report decision regret which is a negative cognitive emotion.
• Controlling workplace hazards – Various studies reveal that nurses face a lot of hazards each day at workplace. These include exposure to blood borne pathogens, dermatitis, injuries, flu germs and much more. To prevent such hazards, hospitals and health systems can prepare to protect their workforce by including extra measures. For example, a vaccination for nurses, antiviral face masks etc.
• Interning new nurses – Internship programs should be started for nursing as well where youngsters are trained about the hazards currently and how to deal with each. They should be explained their role in the healthcare process and how each one of them is significant. This shall instil a sense of belongingness and responsibility in them. (Dolansky 2013)
Although there are contemporary nursing processes in place like the Magnet Recognition program, there is still a lot to do. The Magnet Recognition program designates organizations globally wherein nursing leaders successfully align strategic goals to improve the organization’s patient outcomes. The program is like a roadmap to excellent nursing. For nurses, it means guidance and development at every stage of their career whereas for patients it means the best care delivered by nurses. (Zimmermann 2019)
The term magnet refers to the concept of attracting and retaining quality nurses. It aims at an ability to create a work environment that recognizes and rewards nurses who practice professionally. The benefits of Magnet program include a high standard of care for patients, motivated and valued staff and Business growth and financial success. The journey to this program requires a lot of dedication from the organization as well as the staff. The organization needs to continuously evaluate strength, weakness and performance of the staff. This results in an environment which inspires nurses to work together.
Organizations which implement this program are recognized by the ANCC (American Nurses Credentialing Centre). It fosters a positive work environment and a sense of pride amongst the staff. The core values of Magnet program include respect, empowerment, pride, mentoring, team work and integrity. These outcomes are backed by science as well. There are studies to assess patient condition through various methods explained by nursing theory. There are theories and researches which assists nurses to describe, explain and predict their experiences. They also help in building a common nursing terminology which can be used while communication with other professionals. The researches have also enhanced autonomy of nursing.
The nursing process in fact has been suggested as a scientific method which guides procedures and qualifies nursing care. Most hospitals do not apply the nursing process owing to time shortage or imbalance between nurse and patient ratio. There are other hospitals who do not apply the nursing process because of resource scarcity and lack of adequate knowledge (Chism and L.A. 2017). There are instances where one nurse has served 45 patients. QSEN also known as Quality and Safety Education in Nursing is an important concept popping up lately. It is a national movement guiding nurses to redesign the ‘what’ and ‘how’ they deliver nursing care, so that a high quality and safe care is ensured. It helps nurses identify and bridge gaps between what is and what should be. (Chenot et al. 2019)
The goal of QSEN has been to address the challenge of preparing future nurses with six focus area competencies which include- Patient-centered care, teamwork and collaboration, evidence based practice, quality improvement, safety and informatics. (Berman et al. 2016)
On analysing the contemporary nursing practices like Magnet and newer methods such as scientific nursing process and QSEN, we see several points of articulation amongst these. Safety of nurses and high quality care are other points of similarities in these processes. However, there are also points of differences between these methods. Contemporary Practices involve more qualitative aspects and are focused on nurses currently serving organizations. QSEN is more of a futuristic process where nurses for the future are to be prepared keeping in mind the hazards faced today. The ethical framework suggested here involves the key aspects of both the contemporary and QSEN approach.
All these approaches aim to build a healthier nursing environment. The Magnet program targets organizations and rewards them for implementing better nursing practices. The organizations therefore, strategize their programs and provide transformational leadership to nurses and hence there is an overall growth of the organization. The main aim is to impoverish structural empowerment with new knowledge, innovations and improvements. The scientific process is more about educating the nurses on the job. QSEN also focuses on training and quality improvement. The targets of each of these methods are same, with only slight variations in the adoption process. The primary aim is to improve standards of healthcare and all its stakeholders, mainly the nurses.
Aiken, L.H., Sloane, D.M., Lake, E.T., Agosto, P. and Roberts, K.E., 2018. Is Magnet recognition associated with improved outcomes among critically ill children treated at freestanding children's hospitals?. Journal of critical care, 43, p.372.
Berman, A., Snyder, S. and Frandsen, G., 2016. Kozier & Erb's Fundamentals of Nursing: Concepts, process and practice. Boston, MA: Pearson.
Chenot, T.M. and Christopher, R., 2019. A statewide initiative integrating Quality and Safety Education for Nurses (QSEN) through academic-clinical partnerships to improve health outcomes. Journal of Professional Nursing.
Chism, L.A., 2017. The doctor of nursing practice. Jones & Bartlett Learning.
Davila, Y.A., 2019. QSEN Competency Confidence Levels in Two Groups of New Registered Nurses.
Dolansky, M.A. and Moore, S.M., 2013. Quality and safety education for nurses (QSEN): The key is systems thinking. Online Journal of Issues in Nursing, 18(3), p.1.
Friese, C.R., Xia, R., Ghaferi, A., Birkmeyer, J.D. and Banerjee, M., 2015. Hospitals in ‘Magnet’program show better patient outcomes on mortality measures compared to non-‘Magnet’hospitals. Health Affairs, 34(6), pp.986-992.
Zimmermann, E. and Alfes, C.M., 2019. Simulating the Role of the Parent: Promoting Family-Centered Nursing Care. Nursing education perspectives, 40(2), pp.121-122.
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