Understaffing is widely considered a primary nursing issue globally, with many nursing leaders and scholars claiming it to be detrimental to patient outcomes. However, in this context, it is not considered that there are many other professional factors at play that lead to poor results in inpatient care. Low levels of nursing are not strongly associated with the actual quality of care since the latter depends on nurses’ competence, nurse-patient communication, and the available resources to a much greater degree.
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While low staffing levels are continuously mentioned in the clinical and administrative aspects of nursing, it is vital to consider that nursing consists of a complex system and predetermined set of tasks, most of which are fulfilled no matter the staffing level. An alternate viewpoint on the issue suggests examining the perspective of efficiency and competency. It is argued that staffing causes nurses to be unable to fulfill their duties efficiently and significantly shortens the time spent with patients. However, if methods of multitasking and communication amongst the nursing team and with patients are improved, then patient outcomes could be improved within the realities of the healthcare system.
A decrease in the quantity and quality of communication strongly affects the quality of care. Within the staffing structure of modern hospitals, Portoghese, Galletta, Battistelli, and Leite (2015) argue that nurses are unable to build effective communication that will appropriately divide the workload and optimize key processes, which would significantly improve healthcare delivery.
Nursing education is a contributing factor, as the quality of nursing benefits with an increased focus on communication strategies in education processes rather than issues such as understaffing. Effective communication elements should be naturally built into nursing protocols for the optimal result. Therefore, with properly structured communication and training processes, nurses would be able to meet the diverse needs of patients even in low-staff environments.
1st Rebuttal (Pro-Point)
After the current staffing crisis hit the nursing practice, policymakers and shareholders started looking for ways to optimize services using the available workforce. One of the proposals was to leverage technology as a way of streamlining service delivery. Proponents of the use of technology to justify understaffing argue that inadequate staffing is not directly associated with the actual quality of care that patients ultimately receive.
This argument is one-sided and biased. While service delivery depends on several factors, such as quality and quantity of communication, availability of resources, and the ability to multitask, adequate staffing is the driving force. Even if nurses were good communicators and had all the resources needed for quality service delivery, they would ultimately burn out if they are overworked due to the lack of enough workforces (Driscoll et al., 2018). Effective communication cannot occur in a vacuum. Enough workers are needed to carry out this process. A nurse can only function optimally to a certain level before getting exhausted. For instance, working for over 12 hours would affect nurses’ performance and decision-making.
Undoubtedly, the nurse-to-patient ratio (NPR) can be low at certain times. However, it is not a primary factor for the drop in service quality, but rather the unavailability of resources. According to the theories of Kahouei, Farrokhi, Abadi, and Karimi (2016), nursing consists not only of human resources but also informational, infrastructural, and technological resources as well among others. For example, services such as patient education can be delivered through digital technology and appropriate databases of information that do not require a nursing presence. Furthermore, infrastructure for the effective provision of care and patient communication is often lacking. Therefore, it can be argued that for as long as other supporting resources are lacking, there will be limited effects.
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2nd Rebuttal (Pro-Point)
The availability of resources is a secondary factor in the provision of quality care services in the nursing practice. Understaffing of nurses leads to excess workload, thus affecting the quality of care given to patients. Excess workload, caused by understaffing, can occur at job, unit, patient, and situation levels in a nursing set-up. According to Lee et al. (2017), when nurses are burdened with an overwhelming workload, they are likely to make mistakes and offer poor quality care services to patients. Therefore, patients may pay for these mistakes by having to stay longer in hospitals, contracting secondary infections, and incurring high costs of treatment.
Ultimately, negative patient outcomes are experienced, and client satisfaction levels drop. These occurrences work against the principles of patient-oriented care, where patients should receive quality and timely care for positive outcomes. As such, health care facilities should have enough nurses in a bid to address patient needs promptly and effectively. Overworked nurses with all the resources they need cannot deliver quality services due to burnout and other related factors.
The communication between nurses and patients, which has a profound impact on outcomes both while patients are hospitalized and after discharge, does not directly depend on NPR. When dismantling communication efficacy, Stalpers, de Brouwer, Kaljouw, and Schuurmans (2015) suggest that it consists of various aspects such as culture, language, and personal demeanor. Management of patient needs and overall communication can be enhanced through digital tools and improved communication training, which limits redundancies and allows to quickly establish a clear dialogue with the patient.
In turn, this leads to an improved quality of life and service for patients by nurses, relatively unaffected by staffing levels. This should be considered in implementing administrative interventions and conducting nursing education.
3rd Rebuttal (Pro-Point)
It is true that communication between nurses and patients is a key determining factor of health outcomes and client satisfaction. However, enough nurses are needed in a bid to address all the patients effectively. In cases of understaffing, nurses have to deal with the excess workload, and thus they have to work for long hours to clear the backlog of activities.
Ultimately, these nurses are tired, and even if they are trained and equipped to communicate efficiently with patients, they may make mistakes due to burnout. Understaffing is the leading cause of medication errors in nursing practice. Driscoll et al. (2018) argue that understaffing means nurses will work for long hours to clear a backlog of excess workload that has to be completed every day. This scenario leads to burnout and fatigue, and thus the affected nurses cannot think clearly.
Consequently, the probability of making mistakes and causing medication errors increases significantly among overworked nurses. Medication errors are costly to both patients and healthcare providers. Therefore, in a bid to address the problem of medication errors, enough nurses are required as each is allowed to work for the recommended hours when functioning optimally. This assertion negates the claim that quality service delivery is a factor of good communication between nurses and patients as opposed to adequate staffing.
It is evident that the complexity of nursing care and its effect on patient outcomes depends on numerous factors. While staffing levels unarguably could be improved, they are not the primary cause of such issues as adverse patient outcomes and poor service quality. Improved education, communication efficacy, and additional resources could have profound impacts that would allow even a skeleton staff to efficiently fulfill all duties and establish a rapport with the patients.
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., … Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6-22.
Kahouei, M., Farrokhi, M., Abadi, Z. N., & Karimi, A. (2016). Concerns and hopes about outsourcing decisions regarding health information management services at two teaching hospitals in Semnan, Iran. Health Information Management Journal, 45(1), 36-44. Web.
Lee, A., Cheung, Y., Joynt, G. M., Leung, C., Wong, W. T., & Gomersall, C. D. (2017). Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Annals of Intensive Care, 7(1), 46-55.
Portoghese, I., Galletta, M., Battistelli, A., & Leiter, M. P. (2015). A multilevel investigation on nursing turnover intention: The cross‐level role of leader–member exchange. Journal of Nursing Management, 23(6), 754-764. Web.
Stalpers, D., de Brouwer, B. J., Kaljouw, M. J., & Schuurmans, M. J. (2015). Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: A systematic review of the literature. International Journal of Nursing Studies, 52(4), 817-835. Web.