The nursing staff shortage in US hospitals threatens to turn into an insoluble problem for the healthcare industry. According to the International Organization for Economic Cooperation and Development, there are four nurses for every doctor. Another argument for building up the power of nursing is an aging population. The US Census Bureau predicts the excess of the number of US citizens over 65 over children by 2035 (Juvé‐Udina et al., 2020). This means that the need for geriatric care, including chronic diseases and concomitant pathologies, provided by the nursing staff, is also growing. The ratio of patients and nurses in the hospital is currently inappropriate. Due to an increase in patient acuity, there is a need for the development of a proposal for a new staffing matrix.
The shortage of licensed nurses affects the staff of the hospital and its patients. People turn away from the clinic if there is not enough staff for proper treatment. When nurses are overworked, they are not able to provide adequate care to patients and make mistakes. This can have tragic consequences for patients and their families, not to mention serious consequences for their jobs (Wheatley, 2017). Working nurses are mentally and physically exhausted, resulting in high job dissatisfaction. Therefore, the hospital has to take measures and hire more personnel, especially licensed nurses who hold a bachelor’s degree, to solve these issues.
Several measures should be taken since it is important to establish strict personal workload values in different departments: from one to eight patients per nurse. To facilitate the discussion of potentially viable solutions, I have selected the following options for a more detailed review. First, the hospital should increase the efficiency of nursing service management based on a review of the role of nursing personnel in the treatment and diagnostic process (Hunt, 2018). Secondly, the hospital should implement a new organizational structure based on parallel equal structures, in which the chief physician controls the work of doctors, and the chief nurse controls the work of all nurses with different levels of education, without direct subordination of nurses to doctors (Hunt, 2018). Nurses and physicians work equally and independently within their mandate, bearing collective responsibility for the activities of the interprofessional team. The hospital needs to hire more registered nurses who will supervise assistants and nurses and perform a wide range of functions. They will assess the condition and symptoms, keep the patient’s medical history, provide patients with medications, collaborate with other medical specialists, and consult with doctors to create a personalized treatment plan (Wheatley, 2017). RNs provide emotional, psychological, and spiritual support to the patients, their families, and friends. They will act as a kind of mediator between the patient and the clinic. I suggest hiring nurses who hold a bachelor’s degree in science in nursing despite the required minimum being an associate degree in nursing. An increase in the number of nurses with a bachelor’s degree by 10% will be directly proportional to a decrease inpatient mortality (Saville et al., 2019). They will carry out the nursing process independently of the doctor, autonomously, within the framework of the delegation of functions. For example, they will be responsible for screenings, follow-up, self-admission, clinical examination, and may lead health schools. They will also participate in the development of guidelines, organizational activities, research, and nursing management. The hospital may also offer continuing education for the regular staff. Not all nurses have the necessary qualifications and competencies to conduct an independent nursing process. Therefore, we need to hire more licensed practical nurses who will fill out medical records, provide and coordinate patient care, inform patients about various diseases, and provide counseling and support to patients and their families. We also need to increase the staff of nurse practitioners as they can replace general practitioners (Wheatley, 2017). After getting a master’s degree and becoming an advanced registered nurse practitioner, a registered nurse will prescribe some medicines herself, manage patients, and be responsible for their condition. The hospital needs to hire licensed nurses in the long run. They must have a degree as licensed practitioner nurses or registered nurses. Both must complete their educational programs and obtain a license. A licensed staff increasingly performs actions that have been previously done only by a doctor. It takes more education and clinical hours to get a registered nurse license. Moreover, they are trained to care for acutely ill patients. Licensed nurses can care both for stable patients and more challenging ones (Juvé‐Udina et al., 2020). Certified nursing assistants are not licensed and have to be guided by a registered or licensed practical nurse. They can provide basic care and non-decision-making tasks, but the hospital will benefit only from licensed and professional personnel. Travel nurses may become the personnel reserve of the hospital. Their employment, usually for up to 13 weeks, is handled by special recruiting companies that help hospitals close vacant nursing positions. According to Staffing Industry Analysts, US hospitals paid $ 4.8 billion for migrant workers in 2017 (Saville et al., 2019). The demand for these nurses is growing, as well as for the nurses who come from other countries for permanent residence under a special program for representatives of scarce specialties. Potential barriers to implementing the proposed staff matrix include high workloads on nurses, burnout at work, and staff drain due to imperfect pay and mismatch of expectations. The need to increase the payroll, especially for nurses who hold a bachelor’s degree, limits the scope of the staffing table. Low staffing and high workload negate the benefits of increased nursing hours (Saville et al., 2019). A nurse with a bachelor’s degree usually has difficulty if her workload is more than eight patients. Low satisfaction with the nursing work environment can negatively affect patient outcomes and mortality. Insufficient funding for research in nursing can affect the quality of nursing practices from an evidence-based perspective. To achieve the potential benefits, the following steps are needed to minimize the risks. New financial mechanisms should be provided to increase funding opportunities and ensure an adequate level of nursing staff. Financial mechanisms to support nursing research should also be envisaged to introduce the best evidence-based nursing practice. To sum up, now more than ever, nurses constitute an important and valuable segment of the medical profession. The implementation of a new nursing staffing plan can change working conditions and make the process more manageable. The implementation of these measures will ensure increased responsibility for the results of work and increased patient satisfaction with the work of nurses. It will help to decrease the incidence of complications associated with the nursing process and improve health indicators in patients. The new nursing staff plan will reduce the frequency of potentially preventable hospitalizations, as well as optimize health care cost structures by preventing patient complications and improving public health.
Hunt, P. S. (2018). Developing a staffing plan to meet inpatient unit needs. Nursing Management, 49(5), 24-31.
Juvé‐Udina, M. E., González‐Samartino, M., López‐Jiménez, M. M., Planas‐Canals, M., Rodríguez‐Fernández, H., Batuecas Duelt, I. J.,… & Asensio‐Flores, S. (2020). Acuity, nurse staffing and workforce, missed care and patient outcomes. A cluster‐unit‐level descriptive comparison. Journal of Nursing Management, 28, 216-2230.
Saville, C. E., Griffiths, P., Ball, J. E., & Monks, T. (2019). How many nurses do we need? A review and discussion of operational research techniques applied to nurse staffing. International Journal of Nursing Studies, 97, 7-13.
Wheatley, C. (2017). Nursing overtime: Should it be regulated? Nursing Economics, 35(4), 213.