Organizational Policies and Practices to Support Healthcare Issues

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.

To Prepare:

• Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
• Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.

By Day 3 of Week 3

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

By Day 6 of Week 3

Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.

student one

The national healthcare infrastructure is being stressed of its resources to provide needs to the opioid use disorder (OUD) patient population. Opioid Use Disorder (OUD) is both a physical and psychological dependence and is recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a mental disorder (Kosten, & Baxter, 2019). An article by Horner, et al., discussed that due to the opioid epidemic, health care workers are encountering an increasing number of patients who have opioid use disorder in addition to complex social, behavioral and medical issues (2019). A different article by Cash further discusses the complex needs of OUD, “Patients with OUD have poorer overall health and worse health service outcomes, including higher rates of morbidity, mortality, HIV and HCV transmission, and 30-day re-admissions. With the rate of fatal overdoses from opioids at crisis levels, leading scientific and professional organizations have declared OUD to be a public health emergency in the United States (2019).”

The competing needs, such as the nursing shortage, ethical decision, limited resources, and no OUD cure have impacted the way institutions are addressing the opioid crisis. Both RN and hospitals, are having to face ethical dilemmas in treating OUD patients, as the treatment for OUD requires a complex amount of care. The American Nurses Association (ANA) suggests that RN aim for a restructured healthcare system that considers nursing as a specialized body of professional knowledge that attends to and cares for people’s physical bodies and mental health (Kelly, & Porr, 2018). Healthcare organizations need to develop further policies that consider the RN voice in the treatment plan of OUD patients. My organization currently is lacking policies that address the competitive stressors that RN are facing in providing treatment to OUD patients.

References

Cash, J. (2019). Ethical considerations in the care of hospitalized patients with opioid use and injection drug use disorders. Journal of hospital medicine, 14(2), 123.

Horner, G., Daddona, J., Burke, D. J., Cullinane, J., Skeer, M., & Wurcel, A. G. (2019). “You’re kind of at war with yourself as a nurse”: Perspectives of inpatient nurses on treating people who present with a comorbid opioid use disorder. PloS one, 14(10), e0224335.

Kelly, P., Porr, C., (January 31, 2018) “Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 6.

Kosten, T. R., & Baxter, L. E. (2019). Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment. The American journal on addictions, 28(2), 55-62.

student two:

Within healthcare there are needs that need to be met not just for the patient but for the organizations as a whole, such as staff and resources available. To address the needs of the organization those needs have to also align with the policy in this case lack of staffing. The staffing issue that is prevalent at my current occupation and within healthcare in general usually comes down to the available resources and financial constraints (Rafferty, 2018). The successful delivery of patient care in terms of quantity, cost, and quality are a direct result of the utilization of resources and staff within the workforce. Failure to provide these needs is what leads to the issue of shortage in clinical staff especially nurses.

A specific competing need that impacts nursing shortages at my current facility is the ability to place the right nurse with the right patient demographic. Research shows that the overall skills and knowledge of the nurse has a direct result of the patient outcomes. For example, within my current job there are instances where nurses are pulled from their assigned clinic due to low staffing and are placed in another clinic where minimal training was available leading to longer patient wait times and the risk of error especially in the immunization clinic. Patient acuity and nursing workload are entwined in clinical practice and in the literature because patient care needs demand nurses’ time and attention. Patient acuity is defined as assessing the nursing care requirements of patients to determine the amount of nursing time needed to meet those requirements (Paulsen, 2018). Ensuring the nursing capacity fits the patients who will be receiving care is a necessity and provides a balance in available resources to unavailable resources and in turn decreases the costs to the facility through positive care and decreased risk of error.

With workload impacting the patient, staff and organizations resources implementing a policy could help combat this competing need. A policy that ensures the optimal patient to nurse ratio including their education/skill level can improve the nurse turnover rate and improve patient outcomes. When health care employers fail to recognize the association between RN staffing and patient outcomes; laws and regulations become necessary (ANA, 2019). The policy for example could be outlined in a way that nurses with less than one year be assigned to clinics that are more task based and those with more experience handle the more complex clinics while being mindful of patient complexity and how many one single nurse can handle. For instance in the women’s health clinic that sees roughly 40 patient a day should have at least 3 interviewing nurses whereas the prenatal clinic may only need 2 since they see half as many patients. Being mindful of the available staff and their abilities in relation to patient ration would help lessen the burden to new nurses and decrease costs of providing increased training and turnover rates.

American Nurses Association. (2019). Nurse Staffing Advocacy. https://www.nursingworld.org/practice-policy/nurse…

Paulsen R. A. (2018). Taking nurse staffing research to the unit level. Nursing management, 49(7), 42–48. https://doi.org/10.1097/01.NUMA.0000538915.53159.b…

Rafferty, A. M. (2018). Nurses as change agents for a better future in health care: The politics of drift and dilution. Health Economics, Policy and Law, 13(3-4), 475-491. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1017/S…