As a nurse myself, I have experienced first-hand the struggles of the shortage. My first experience was that of a student and that was nearly 15 years ago. The community college that I started my nursing education with was in El Paso, Texas. It was very difficult to be able to get accepted into the program because they only offered 35 slots and entrance was only given every two years. You had to compete with your GPA in the non-nursing courses, write an essay to the nursing faculty, and pray you got accepted. This was because of the nursing shortage. There were only three instructors and these 3 women taught every single class. Not enough faculty members to teach were one of the reasons for the shortage at that time.

Now let’s fast forward a few years. With a move to a new city and state I made a career and educational move as well. I completed my Bachelor of Science in Nursing and eventually became a Director of Nursing (DON) at a 120-bed nursing home. As the DON, one of my main responsibilities was staffing the home. Pynes & Lombardi (2011) discuss some common mistakes that new managers make when it comes to the interview process. They identified exactly what was happening to me in that I had “several openings and a short time in which to fill them (Pynes & Lombardi, 2011.) Of course, I had some problems, but through prayer, trial and error I learned how to be more selective. James 1:2-3 (NKJV) says “My brethren, count it all joy when you fall into various trials, knowing that the testing of your faith produces patience.” What I found in my interviewing of potential staff was that there were not a lot of candidates applying, the pay was low, and the nurse-patient ratio was extremely high.

The facility I worked for focused on the numbers.  Are there enough “licensed bodies” in place to provide the nursing hours that were required by the state? That was the bottom line. Seventy-five percent of the time I was forced to hire a nurse that I felt was unqualified for the position. I was uncomfortable with hiring a nurse who had no experience working with the elderly. I had concerns about their assessment skills of an older adult patient. I wanted nurses who could provide quality care. The administrator wanted nurses who could help meet the nursing hours. There was no motivation in investing in staffing quality nurses when reimbursement was still given whether providing care at the minimum levels versus care at a higher level of excellence (Fox & Abrahamson, 2009.) I remember the administrator keeping an unqualified nurse on staff that had made several serious mistakes simply because “she was the only nurse available to cover a shift on short notice.” The nurse had not checked on a resident at all during her 12 hour shift and discovered him dead in his bed the next morning when she went in to check his blood sugar. The resident was a full code and CPR was not initiated. The main focus for the administrator was only to meet the required nursing hours for the day regardless of the skills of the nurse.

Ferguson & Lloyd (2017), argue that staffing is not just important when providing healthcare, but “safe staffing is critical for positive patient and population outcomes.” High acuity patients require more nursing care than those that are low acuity. As a young nurse fresh out of nursing school I was very interested in cardiac care. I began working at the local hospital of which I worked as a Student Nurse Tech (SNT) while in nursing school. As a SNT we worked alongside the licensed Registered Nurses (RNs) and Licensed Vocational Nurses (LVNs) in order to gain experience. As an SNT you pretty much worked wherever you were assigned. One evening I came on shift and discovered that it was just myself (the unlicensed student) and one RN working on the cardiac step-down unit with 13 patients. The normal staffing ratio would include 1 RN, and LVN, and a nursing assistant. With the type of critical patients on the unit the RN was very frustrated because these patients are all mid-level to high acuity. This was unsafe for the RN whose license I worked under and the patients we were caring for. At this time acuity-based staffing solutions were not being used. Ferguson and Lloyd (2017) see acuity-based staffing as a means to help with decision-making when it comes to admissions, transfers and discharges. Nursing informatics is a field that is focusing on these types of issues. Even in my two year working as a DON, I was faced with the same problem. Having residents on mechanical vents, tube feedings, frequent blood sugars with minimum staffing becomes frustrating and sometimes unsafe. Taking control of admissions, discharges, and transfers in a systematic manner could have prevented one nurse from having so many high-acuity patients.

The final contribution to the nursing shortage is low pay when compared to other professions. The nurses at the nursing home back then only made $12.75 an hour. The hours were long, the work was hard, and the stress level was high. When it was time for annual evaluations, the nurses were only given a raise of 10 to 25 cents more an hour. Instead of being given time off to take a vacation, which most could not afford to do, they are given a check to the equivalent of one week of their pay. I lost most staff to the local hospitals because the shortage was so bad that they began offering $5K bonuses to attract nurses to come and work for them. When employers began offering student loan repayment and tuition vouchers, Fox and Abrahamson (2017), argue that this method of recruitment made it so much easier for employers to offer a low wage. Most of the nursing in my graduating class, including myself, were offered bonuses for 1-2 year commitments. I gave the cardiac unit 1 year and only stayed that long so I did not have to repay the bonus. I left because of poor staffing on a unit with such critical patients.

My recommendation to ratify the nursing shortage would be for nurses to be able to specialize, maybe in their final year of the baccalaureate program, in the particular field as to which they want to work. As a student, you go through each area, pediatrics, mental health, medical-surgical, obstetrics, etc. If in your final year you got to learn more about the one you really fell in love with, that would keep you interested, and maybe not burn out as fast. I also recommend alternate work schedules. Even in administrative nursing we are still at a shortage. We desire to get the work done, but cannot always do it within the confines of the office, or structured work day. My next recommendation would be free continuing education for current nurses that wish to train in other areas. There are so many technological advances out right now and things change such as new medical equipment, new ways to perform a procedure. I would like to be able to explore those things as a way to market myself for other opportunities to learn new nursing skills.

Fox, R. L., & Abrahamson, K. (2009). A critical examination of the U.S. nursing shortage: Contributing factors, public policy implications. Nursing Forum, 44(4), 235-244. doi:10.1111/j.1744-6198.2009.00149.x

Ferguson, S. L., & Lloyd, J. (2017). Innovative information technology solutions: Addressing current and emerging nurse shortages and staffing challenges worldwide. Nursing Economics, 35(4), 211

Pynes, J. E., & Lombardi, D. N. (2011). Human resources management for health care organizations: A strategic approach. San Francisco, CA: Jossey-Bass.

Discussion #2

Depending upon what research a reader would apply to understanding where the national shortage of both physicians and nurses comes from: be it one factor, or combination of factors the result is the shortage is rampant and ongoing. For the past two decades in both the United States and Canada the economy experienced colossal shortages across the health care profession ranks. (Pynes & Lombardi, 2011,).

Directly pinpointing physicians as a focus I chose to deduce the physician shortage to a combination of factors beginning with the fundamentals of math. From a simple ratio perspective assuming a traditional model outlook of patients being care for by a single physician, there is one physician for every 2,500 patients. The odds of achieving and maintaining a balanced physician –to-patient ration would be difficult. (Green Savin, & Lu, 2013).

Another factor of area to consider which directly contributes to the national physician shortage “is the gap between the adult populations demand for primary care services and the capacity primary care (Bodenheimer & Smith, 2013).” The unmatched physician –to-patient perspective details the concept of the patients access to timely care in taking in account various degrees of patient demand and arrival of patients requests that in joining patients demands, visits and time spent with each patient the result would be a severe backlog and the inference of quality of visit with physician.

Another factor of area to consider which directly contributes to the national physician shortage “is the gap between the adult populations demand for primary care services and the capacity primary care (Bodenheimer & Smith, 2013).” The demand is greater than the physicians avaliable to supply the need a strategy of offset must be looked at a way to supply for patient needs. Strategies to rectify the physician employment issue specifically the physician –to-patient ratio issue would be implementing teams, non-physicians, and electronic communication to counter the ratio issue. Presumably by creating teams of care and have the non-physicians support the physicians more consistent amounts of patients can be seen per day. By increasing electronic communication would minimize the face-to-face appointment and the time saved could be devoted to quality physician visits.

Additional strategies to suggest to rectify the employment issue of physicians would be efficiently use all personnel staffed in the capacity of health care professionals. That means empowering nurses and pharmacists who fall under licensed personnel to provide more care. Also that means instating standing orders for all for medical assistants who fall under nonlicensed health personnel to function in higher required needs of health coaches to provide preventive care needs. (Bodenheimer & Smith, 2013).” By utilizing all health care personnel available there is more time for the team of professionals to take care of the needs of the patients. If additional hiring needs to take place health care human resource departments are adamant is correct placement.

Ensuring the overarching goal is reached which is to hire physicians who “would contribute to the progressive improvement of performance across the organization (Pynes & Lombardi, 2011, p. 178).” Biblical integration can be related to Acts 20: 35 which read “In all things I have shown you that by working hard in this way we must help the weak and remember the words of the Lord Jesus.” By analyzing and finding all strategies that result in heightened patient access and quality care would be working hard in the way in which the book of Acts describes. As medical services abilities and what is being offered to the consumer has grown facilities and support capabilities of delivering services has not which directly correlates to the workforce manning one being able to keep up with the demand and provide the services in a timely manner.

References

The Holy Bible, English Standard Version. (2016).

Pynes, J. E., & Lombardi, D. N. (2011). Human resources management for health care organizations: A strategic approach. San Francisco, CA: Jossey-Bass. ISBN: 9780470873557. Green, L. V., Savin, S., & Lu, Y. (2013). Primary care physician shortages could be eliminated through use of teams, non-physicians, and electronic communication. Health Affairs, 32(1), 11-9. Retrieved from http://ezproxy.liberty.edu/login?url=https://search-

proquest-com.ezproxy.liberty.edu/docview/1285127946?accountid=12085

Bodenheimer, T. S., & Smith, M. D. (2013). Primary care: Proposed solutions to the physician shortage without training more physicians. Health Affairs, 32(11), 1881-6. Retrieved from http://ezproxy.liberty.edu/login?url=https://search-proquest-com.ezproxy.liberty.edu/docview/1458312676?accountid=12085

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Respond to threads posted by 2 classmates who analyzed a different area of practice than you did. Compare and contrast the legal and ethical issues of your area of practice with those explored by other students. 2 replies of at least 450 words each to 2 classmates’ threads.  Each reply must be supported by 4 scholarly sources, including the textbook chapter and the Bible, cited in current APA format (note that this is a different requirement than the previous Discussion Board Forums).

My Post: Chapter 11: Nursing and the law

Introduction

As analyzed in the book in chapter 11, the profession of nursing always intersects with legal risks which might include negligence or malpractices. In addition, nurses are always faced with the dilemma of selecting the ethical and moral choice every single day within their places of work. Thus, in the nursing field, the law applies to every major activity carried within a health facility. Nurses therefore face legal risks in their day to day duties and they are also required by law to question any discharge of a patient from the hospital especially if the patient is not completely healed. In addition, they are also required by law to report negligence observed in a physician as required by law.

Therefore, the legal issues and ethical issues facing my profession require me to observe the law at any given time and act in a way which is unquestionable and promotes the highest ideals of our nursing profession. In the following discussion, I will look into legal issues impacting the nursing profession while at the same time exploring how my ethical viewpoint coincides with biblical values.

Legal issues in nursing

In the nursing profession, may legal issues exist for a nurse as noted by the studies made by Cox, (2010). The legal issues include negligence which occurs when a nurse fails to provide the expected level of care to a patient. In addition, other legal risks that nurses face include malpractice which entails a nurse doing something wrong contrary to the training received. E.g., as a nurse, I might give the wrong medication to a patient as a result of fatigue or other factors leading to very negative medical effects on the part of the patient. This might result to the institution I work with getting sued by the patient. Further, as analyzed by Cox, (2010) legal risks which also face nurses in their day to day work include accidents and documentation errors especially when nurses are filling health records which might result to misdiagnosis in the future.

Further as noted by (Pozgar & Santucci, 2015), nurses should have the proper licensing and certification allowing them to practice their profession in a particular state or they face the risk of being sued for fraud and malpractice.

On the other hand, nurses also face the legal risk of getting sued if they do not question how a contentious discharge was carried out. This is as analyzed by (Ulrich et al., 2010) who show that nurses have an obligation to ensure that patients receive the best care which an hospital can grant and that they are not discharged midway through a treatment process due to their inability to pay for their hospital bills. Nurses, therefore have a moral obligation to stand for what is right within their profession and adhere to the Hippocratic Oath by ensuring that doctors disseminate quality care to all the patients admitted within a hospital.

Finally, as noted by (Pozgar & Santucci, 2015) nurses also have a right to report any negligence on the part of a physician. This is because, failure to do so may result to the nurse getting embroiled in a legal conflict if the actions of the physician leads to negative outcomes on the part of the patient. Therefore, nurses face the legal risk of suspension or getting their certificates revoked if they do not report any form of negligence noted on their fellow physician to their superiors.

Personal worldview on nursing ethics

I tend to agree with the concepts raised by (Ozaras & Abaan, 2016) on the role nurses should play within the society. This is because the author argues that nurses should seek to maintain the highest levels of professionalism in their day to day activities and should seek to follow the law despite the pressure which might come from their work entrapment. Therefore, I believe that nurses should seek to uphold the highest code of ethics and should not in any way accept bribes or subvert the legal guidelines within a hospital setting in order to favor one patient against another. E.g., a nurse should seek to give patients the right amount of morphine despite the insistence of a patient or the pain they might be undergoing

In addition, I also agree with the concepts proposed by (Beech, 2007) that nurses should seek to provide high quality care to any patients who are under their care even if they do not have the means to pay for the care given. Thus, nurses should never deny an individual access to medical help in line with the Hippocratic Oath but should always seek to resolve any insurance constraints or conflicts which can occur in the modes of payment used by a patient while at the same time upholding the professional standards required. Nurses should therefore seek to ensure that a physician adheres to the right code of conduct and act with the right amount of concern towards their patients.

Biblical concepts which intersect with legal nursing laws

The concepts of ethics and doing the right thing are also spoken in the bible. This is as shown in proverbs 11:3 “The integrity of the upright will guide them, but the crookedness of the treacherous will destroy them”. This seeks to show that every person in a position of authority should seek to do the right thing. Thus, a nurse should always seek to uphold the legal and ethical mores and standards stipulated in their job. In addition, they should seek to uphold the correct professional standards in their day to day operations. Therefore nurses should seek to uphold the concepts analyzed in Philippians 4:8 which states “Finally, brethren, whatever is true, whatever is honorable, whatever is right, whatever is pure, whatever is lovely, whatever is of good repute, if there is any excellence and if anything worthy of praise, dwell on these things”.

Conclusion

Therefore, nurses face a lot of legal risks in the workplace as noted by (Pozgar & Santucci, 2015). This is because nurses face the risk of being sued for negligence or malpractice especially if their actions lead to an accident in the dissemination of healthcare. Further, nurses are also supposed to report any misdemeanor carried out by a physician in the workplace. Thereby, a nurse should always uphold the highest ethical ideals in their day to day practices in line with biblical concepts which call on all of nurses to be upright and blameless in their actions.

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Write a Post of 350–400-word reply to each Discussion, include a biblical integration and at least 2 peer-reviewed source citations in current APA format in addition to the text.

Discussion #1

The discussion board for the week asks to evaluate and determine if in charge of a healthcare facility’s human resources, how would one act in the likelihood of a union formation?  The first thing that should be considered is the organization’s current policy on union formation, as well as meeting with leaders within the organization to see if the policy would be amended provided the group seeking representation is able to fully communicate the reasoning for union formation.  After these discussions with the leaders of the organization, this would dictate the appropriate action to take.  As a leader in human resources it would be expected that one would be able to present on any pertinent information regarding union formation to the executive leaders.

The first matter to consider is the group that would like to unionize.  Most often a group wants to unionize in order to bargain on wages and working conditions as they are viewed as unsatisfactory.  It is the belief of this author that if an organization is treating their employees appropriately and operating justly, that there would be no desire to unionize.  The Bible advises all, “for rulers are not a terror to good conduct, but to bad.  Would you have no fear of the one who is in authority?  Then do what is good, and you will receive his approval, for he is God’s servant for your good” (Romans 13:3-4, English Standard Version).  Essentially, if an organization, for profit or not-for-profit is behaving ethically to their stakeholders, employees should not feel the need to seek extra labor protection, however, a good leader should not prevent or stifle the ability for employees to unionize, and should listen to the needs of the group at hand.

Next the leadership would need to know how unions are handled in similar organizations or environments.  Currently as the National Labor Relations Act (NLRA) stands, individuals working in healthcare or in a non-profit setting are allowed to unionize (Kearney, 2010).  Typically, in the healthcare industry, professions are grouped together by similarities for union formation in order to address the specific needs of each group appropriately (Sanders & McCutcheon, 2010).  It would not be appropriate for nurses and housekeeping staff to be represented together.

The next matter to consider is if the state is a right to work state or not (Lombardi & Pynes, 2011).  It will be imperative that both sides understand what it means to be a right to work state and how that could affect the formation of a union.  This author resides in Virginia which is a right to work state which means a union can be formed but neither the union nor the organization can require of penalize an employee for not being a part of the union.  This may make it difficult for the group wishing to unionize to form as this limits the incentive for union membership.

As a matter of opinion, this author does not think that healthcare employees should be able to unionize.  It would be the recommendation that the executive leadership listen to the wishes of the group that would like to unionize and address those needs.  It could be handled as simply as re-writing policies, adjusting a benefit, or adapting a work flow process.  The lines in healthcare become blurred with supervisory roles which would lead to complications into recognizing who is included in union membership and who is not.  Most importantly healthcare workers should not be able to strike without notice to the organization as these professions require a duty to serve the community.  A work environment cannot be duplicated every day in the healthcare field, as the patients change, and this is a service industry not a manufacturing industry.

References

Kearney, R. C. (2010). Public sector labor – management relations: Change or status quo? Review of Public Personnel Administration, 30(1), 89-111. doi:10.1177/0734371X09351827. Retrieved from http://journals.sagepub.com.ezproxy.liberty.edu/doi/abs/10.1177/0734371X09351827

Pynes, J. E., & Lombardi, D. N. (2011). Human resources management for health care organizations: A strategic approach. San Francisco, CA: Jossey-Bass. ISBN: 9780470873557.

Sanders, L. G., & McCutcheon, A. W. (2010). Unions in the healthcare industry. Labor Law Journal, 61(3), 142-151. Retrieved from https://search-proquest-com.ezproxy.liberty.edu/docview/848641461?pq-origsite=summon&accountid=12085

Discussion #2

It is interesting that in this assignment we have been tasked to take the position that HR should proactively seek to “reduce the probability or likelihood of union formation.”  The assignment presupposes that having a union in the hospital is bad.  My purpose in this forum is to determine why a union is not good for the hospital and what management should do to prevent one from forming.

From a management standpoint, unionizing would likely make the hospital less productive financially. In the study by Sanders and McCutcheon (2010), they determined that although proportionally there are fewer unionized workers in healthcare today, unionized workers still command up to an 8% higher wage than non-union workers.  They also determined that non-union wages increased at the same rate as union wages.  Labor unions still have successful bargaining capability and powerful lobbying efforts that have created better standard of living for everyone  (Coombs, Newman, Cebula, & White, 2015).   If wages are still one of the primary motivators for joining a union, the tactic to prevent a union from forming would be to pay employees a wage that is close to or equal to what unionized hospitals pay.  Coombs et al. (2015) explain that this is exactly what hospitals do.  The tactic is called “threat” effect where management pays workers “efficiency” wages to remove, or at least neutralize, the primary incentive for unionizing (Coombs et al., 2015, p. 443).

Traditionally, unions were formed to increase wages, create safe working conditions, and provide benefits such as insurance, vacation, and retirement pensions (Pynes & Lombardi, 2011).  Safe working conditions and most of these benefits are common place in most industries today.  This is perhaps why there is less interest in hospital unions.  As Sanders and McCutcheon (2010) point out, unions in the service industry have shifted away from traditional roles in manufacturing.  In February 2009, three of the largest nursing unions in the country combined to form the National Nurses United (NNU).  They announced their primary role as protecting rights of nurses including passing the National Nursing Shortage Reform and Patient Advocacy Act (Sanders & McCutcheon, 2010).  One could make a case that much of what nursing unions want today is good for patients and good for healthcare in general.  Nurses want better working conditions including smaller patient to nurse ratios.  Nurses want better wages and a more substantial pension that will make the nursing field more attractive to young people.  These are reforms that will help the nation avoid a nursing shortage and improve safety and quality of care.

Unions do pose several threats to the peace, tranquility, and productive of a hospital.  The most destructive threat is a strike.  Although very costly, strikes are rare.  Because of the critical nature of healthcare in a community and the vulnerability of the healthcare industry, many states prohibit public sector healthcare workers from striking.  Where public sector healthcare workers can strike, there are may restrictions such as a 90-day cooling off period and an additional 10-day notification prior to beginning a strike (Sanders & McCutcheon, 2010).  On 10 June 2010, a large nursing union in Minneapolis-St. Paul held a 24-hour strike in 14 regional hospitals.  Although it lasted only one day, surgeries had to be postponed and 2,800 temporary nurses had to be hired (Sanders & McCutcheon, 2010).  Another downside of unions is that there is potentially greater tension between employers and employees.

Pynes and Lombardi (2011) point out that the most significant factor in influencing a nurse to join a union is “negative perception of their work climate” (p. 374).  Pynes and Lombardi (2011) make several recommendations to create a positive work climate.  Among other things, they suggest performance appraisals, merit pay systems that are equitably managed, and enriching careers by minimizing routine and boring tasks.

This scripture might well be adapted to this discussion if I were to change the word “fathers” to “managers” and “children” to “workers.”  “And, ye fathers, provoke not your children to wrath; but bring them up in the nurture and admonition of the Lord” (Ephesians 6:4, King James version).

References

Coombs, C. K., Newman, R. J., Cebula, R. J., & White, M. L. (2015). The bargaining power of health care unions and union wage premiums for registered nurses. Journal of Labor Research, 36(4), 442-461. doi:10.1007/s12122-015-9214-z

Pynes, J., & Lombardi, D. N. (2011). Human resources management for health care organizations: a strategic approach (First ed.). San Francisco: Jossey-Bass.

Sanders, L. G., & McCutcheon, A. W. (2010). Unions in the healthcare industry. Labor Law Journal, 61(3), 142.

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