The context
Patients pay part of the cost of treatment, while governments pay the rest in public hospital settings, which is a common outcome of many social health policies. I recently worked in a clinical environment with this characteristic. There was a nursing shortage at the hospital facility that catered for all kinds of patient conditions. The hospital is in an urban area, mostly catering to underserved communities. The health institution was the biggest recipient of gang-related casualties and malnutrition problems compared to other hospitals in the same state. Many patients at the hospital had a problem honoring their part of the medical bill, and they were often retained in the hospital until they could raise more than half of the amount due.
Details of the issue
The hospital receives a high number of new nurse practitioners every year from nurse training institutions. Many come to the hospital for further training. Besides, permanent workers are serving as general medical practitioners, administrators, and consultants. The hospital depends on state funds for its daily activities and makes up for the difference by charging in and outpatients a percentage of their bill. The turnover of nurses at the hospital is very high, despite the high number of incoming nurses every year. Many training nurses do not stay after completing their training. The hospital has a difficult time attracting qualified registered nurses and has to rely on state directives for employees. The hospital operates mostly with a vacant position for a resident nurse; sometimes the number increases to three. The institution has been forced to try to reallocate its funding to entice new nurses to stay longer.
Impact of the issue
There are different causes of nursing shortages in public hospitals. From an economic perspective, the nursing shortage jeopardizes the ability of the hospital to meet its service obligations. As a result, it is likely to miss any performance-based funding assistance. Such outcomes end up causing additional harm through reduced service quality and availability, which lead to a cyclic relationship of low funds and low service quality and availability. From a societal view, the hospital is important in bridging access to health care among the middle-income and low-income earners. It serves a low-income neighborhood and is, sometimes, the only health facility for many households. Its ability to offer sufficient services is critical. Without dedicated nurses, it is challenging to run hospital improvement programs and undertake monitoring and evaluation data that can help in sustaining such programs. Reliance on temporary nurses causes the hospital to focus on short-term medical issues and is unable to implement systematic solutions to its problems.
The gravity of the issue
The nursing shortage affects many hospitals due to various factors. The shortage affects the ability of medical facilities and institutions to offer their services to their populations. It curtails the provision of health care, a situation that mainly arises because of the skewed distribution of nurses. There is a rise in the demand for nurses as a result of a rising population of the elderly. This goes on in addition to other demands for nursing. The natural response would be to have more nurses taking up new roles to balance the supply and demand issues. However, it is not happening, as more nurses are not taking up long-term positions at the hospital as they should. Hospitals are the largest providers of managed care and the largest employers of registered nurses (Byrne & Martin, 2015). They have to accomplish a lot and meet the rising demand by relying on resources that increase at a very slow rate. Their programs are tied to state and federal policies, which may require years of legislative debate to change. Unfortunately, the demand for health care services keeps growing.
Proposed solution
Nurse staffing affects the quality of patient care; therefore, the solution for the nursing shortage problem is also a solution for inadequate patient care. The hospital can alter its program to recognize the ability of its short-term registered nurses to serve its needs adequately. It should then create appropriate transition mechanisms to ensure that nurse-related duties are easily transferable. It might require creating a repository of communication, decisions, management activities, patient care data, and human relations to facilitate the easier transfer of patients from one nurse to another. The hospital can be able to manage its workload under its current resources (Byrne & Martin, 2014). An increase in wages is not sustainable because it affects the other operations of the hospital. Focusing on a value and institutional culture system that promotes sharing of resources, including staff resources, can help in the long term. The causes of nurse shortage due to lack of funds could be addressed by additional lobbying to respective state departments on health care (Byrne & Martin, 2015). The creation of a suitable working environment with the appropriate balancing of patient duties and overall nursing workload can make the hospital attractive and cause many short-term nurses to consider becoming residents permanently.
References
Byrne, D. M., & Martin, B. N. (2014). A solution to the shortage of nursing faculty: Awareness and understanding of the leadership style of nursing department head. Nurse Educator, 39(3), 107-112.
Byrne, D. M., & Martin, B. N. (2015). Nursing shortages in the OR: Solutions for new models of education. AORN Journal, 101(1), 115-136.