Translational research for practice & populations

Nurses are health care professionals whose role in the health facilities is to provide various services and care to patients. They are involved in coordinating patients care to achieve optimal health. They also give advice to patients on prevention of diseases and injury. Further, they carry out research on health care issues and formulating of health related policies. Furthermore, they give compassionate care by carefully taking into consideration every patient’s values, beliefs and needs. In most instances, the nurses get overwhelmed by the unsafe and unrealistic workloads. This paper looks at changes that need to be implemented in the workload for nurses. In most health facilities it is overwhelming, unrealistic and unsafe. This affects the productivity of the nursing in the course of performing their duties.

Current nursing practice: overwhelming, unrealistic and unsafe workloads

Examples of overwhelming unrealistic and unsafe workloads

Nurses get overwhelmed by the workloads in the health care facilities. Their workload includes; taking health histories and performing physical examinations of the patients. They also provide medical care and medication as advised by a physician during treatment of a patient. Further, it is the responsibility of nurses to promote healthy behavior in patients affected by serious or terminal illness and their families through providing mental health counseling. Furthermore, nurses perform health screening in patients for early detection of terminal diseases. Nurses provide individualized care and they make referrals when need arises. In some health facilities where there are no clerical officers therefore nurses perform administrative jobs such as data entry of clinical and nonclinical data. The responsibilities that are given to the nurses are many and in most health facilities there is a high patient: nurse ratio. This overwhelms the nurses since the workload is so much. The responsibilities are too many for the nurses to complete them effectively. This leads to fatigue and this becomes unsafe for both the nurse and the patient. When most of the duties in the health facilities are given to the nurses, they feel dissatisfaction as they work since their efficiency goes down and they end up performing poorly. When the performance is poor, it causes dissatisfaction as the nurses to feel inadequate as they perform their duties.

Reasons why the nursing practice needs to be changed

The issue of overwhelming unrealistic and unsafe workloads needs to be addressed. The high workload that is caused by the reduced nurse-patient ratio needs to be addressed because it affects the performance of nurses as they carry out their duties. The issue needs to be changed because the nurses are not able to deliver quality patient care since they are required to take care of many patients and they work for long hours. The unfavorable long working hours lead to fatigue and this causes lack of motivations among the nurses leading to poor performance (Klein, 2013).  The shifts go for up to twelve hours without breaks and this leads to burnout for the nurses. Constant fatigue that is experienced by nurses causes dissatisfaction to them. The primary duty of nurses is to spend time with patients and give them comfort care which should. If they do not have enough time to do this, they feel inadequate and dissatisfied. Increase of nurses in a health facility leads to a decrease in morbidity, mortality and the cases of readmission of patients. If the issue of the high workload is addressed, there would be successful decrease of these cases.

Reducing the work for the nurses would motivate them and this leads to increase in productivity which helps in achievement of excellence in care of patients. The issue of high workload should be addressed so as to improve the nurses’ relationship with patients due to reduced stress and this leads to better quality patient care. Increase in time for nursing care is likely to improve patient safety since it would prevent complications and infections and further promote good health. Addressing the issue would have an effect on the time that they allocate to different tasks. Heavy workloads deny nurses sufficient time that they need to perform tasks that are related to patient safety. It also leads to reduced time that a nurse spends communicating and collaborating with other physicians and this causes poor communication with patients. It further affects the quality of the collaboration with other physicians. A change in workload of the nurses can reduce cases of low morale, poor job performance, high employee turnover and absenteeism (Koithan, 2014). High workload leads to distress and emotional exhaustion and therefore the nurses are not able to perform their duties efficiently and effectively and therefore it needs to be addressed. If the issue is addressed, the poor performance that is caused by the huge workloads will be eliminated. Addressing the huge workload issue will reduce the occurrence of slips and lapses and the execution of errors.

Key stakeholders and their roles within the healthcare setting

Among the key stake holders in health facilities is the senior management staff. They are responsible for formulating of goals and strategies for the health facility which guide employees as they perform their duties towards accomplishing them. They also make the major decisions concerning the health facility. Their role in addressing the issue would be to ensure that as they distribute the duties that will facilitate achievement of the goals and strategies fairly among the staffs who are working in the health facility. This will avoid the high overload on nurses. They should further provide adequate financial resources so as to employ enough staff to enable increase the nurse-patient ratio. Another stake holder is a nurse administrator who is responsible for managing, planning, directing and organizing of operations and implementation of policies in a health facility. They make operating decisions, provide general supervision, employ and lay off staff. They also coordinate all the services provided in the health facility. The nurse administrators can help the in addressing the issue by organizing shifts that are favorable for nurses (Bell, 2015).  They can also identify areas that need more employees and make recommendations to the senior management. Further, the can reduce the fatigue and burn out for the nurses by ensuring that in their work schedules there are breaks within the working hours

Registered nurses are also key stake holders in a health facility. They are health care professionals who they provide various services and personalized care to patients. They are involved in coordinating patients care to achieve optimal health. They also give advice to patients on prevention of diseases and injury. They are also involved in carrying out research on health care issues and formulating of health related policies. Their role in addressing the issue would be making effort to share responsibilities fairly among the staff working under them to avoid work overload on the nurses. They can also make recommendations as they conduct research to ensure that the issues of high workload and poor staffing are publicized and addressed.

Evidence critique table

Sources	Evidence Strength (1-7) and Evidence Hierarchy
1 (Campbell, 2013). Nursing Management: Principles and PracticeNursing Management: Principles and Practice. Nursing Management, 20(3), 9-9. doi:10.7748/nm2013.06.20.3.9.s15	2 and Randomized controlled trial (RCT). Health care facilities have overwhelming, unrealistic and unsafe workloads   The responsibilities that are given to the nurses are many and in most health facilities there is a high patient: nurse ratio. This overwhelms the nurses since the workload is so much. High workload leads to fatigue and this becomes unsafe for both the nurse and the patient. Overload of patients leads to poor patient care and burnout which results from the nurses becoming overwhelmed by their work
2. (Koithan, 2014). Concepts and Principles of Integrative Nursing. Integrative Nursing, 3-16. doi:10.1093/med/9780199860739.003.0001	1 and systematic reviews   The unrealistic workload that is as a result of the reduced nurse-patient ratio needs to be addressed because it has a negative impact on patients. Nurses are not able to deliver quality patient care since they are required to take care of many patients and they work for long hours. Understaffing makes nurses get overwhelmed and it leads to burnout for the nurses. The huge workload reduces the time nurses spend with patients to give them comfort care which should be their main role in the health facilities.
3. Eric De Jonge, K., Jamshed, N., & Taler, G. (2014). Effects of Nursing on Medicare in   Primary Healthcare. Journal Of The American Geriatrics Society, 74(10), 1905-1910.	1 and systematic reviews   Employing more nurses in a health facility leads to a decrease in morbidity, mortality and the cases of readmission of patients. Reducing the work the nurses would motivate them and this leads to increase in productivity and this helps in achievement of excellence in care of patients. Reduced workloads improve the nurse’s relationship with patients due to reduced stress and this leads to better quality patient care.
4 Golberstein, E., & Gonzales, G. (2015). The Effects of Medicaid Eligibility on Health   Services and Nursing Health Services. Health Services Research, 50(6), 1734-1750.	2 and Randomized controlled trial (RCT).   Increase in time for nursing care is likely to improve patient safety since it would prevent complications and infections and further promote good health. Heavy workloads deny nurses sufficient time that they need to perform tasks that are related to patient safety. High workload leads to reduced time that a nurse spends communicating and collaborating with other physicians and this causes poor communication with patients.
5. Peikes, D., Chen, A., & Brown, R. (2013). Effects of care coordination on hospitalization, quality of care, and health care expenditures among Healthcare beneficiaries: 15 randomized trials. Jama, 312(6), 603-618.	2 and Randomized controlled trial (RCT).   Heavy workloads deny nurses sufficient time that they need to perform tasks that are related to patient safety. High workload among nurses workload leads to low morale, poor job performance, high employee turnover and absenteeism. High workload leads to distress and emotional exhaustion and therefore the nurses are not able to perform their duties efficiently and effectively. The poor performance may compromise the care and safety of patients.

Evidence summary based on the findings

The evidence from the findings indicates that in most health facilities, the nurses get overwhelmed by the unsafe and unrealistic workloads. It is clear that the nurses are not able to deliver quality patient care since they are required to take care of many patients and they work for long hours. The huge workload reduces the time nurses spend with patients to give them comfort care which should be their primary duty in the health facilities (Campbell, 2013).  The research found that heavy workloads deny nurses sufficient time that they need to perform tasks that are related to patient safety. Furthermore, it leads to low morale, poor job performance, high employee turnover and absenteeism. The nurses exhibit poor performance which may compromise the care and safety of patients due to distress and emotional exhaustion caused by huge workloads. The workload overwhelms the nurses and this reduces their motivation to work.

Reducing the workload would lead to increase in productivity thus helping in achievement of excellence in care of patients (Koithan, 2014). According to the evidence results, reduced workloads improve the nurse’s relationship with patients due to reduced stress and this leads to better quality patient care. It is evident that increase in time for nursing care is likely to improve patient safety since it would prevent complications and infections and further promote good health. The findings show that high workload leads to fatigue and this becomes unsafe for both the nurse and the patient. Overload of patients leads to poor patient care and burnout which results from the nurses becoming overwhelmed by their work and this leads to poor performance (Eric, Jamshe & Taler, 2014).  The evidence results further indicate that reduced workloads improve the nurse’s relationship with patients due to reduced stress. Poor performance may compromise patients’ care and safety (Golberstein & Gonzales, 2015). The author further explains that heavy workloads deny nurses sufficient time that they need to perform tasks that are related to patient safety. The huge workload reduces the time nurses spend with patients to give them comfort care which should be their primary duty in the health facilities (Peikes, Chen & Brown, 2013). Involvement of the key stakeholders in the health facilities can help in addressing the challenges that are faced by the nurses as they perform their duties.

Best practice based on the evidence summary

The issue of the huge workload can be addressed by implementing some of the best practices that will reduce the workload. The best practice that would be recommended is by using evidence based practice to improve the efficiency and productivity of the nurses. The use of evidence based practice to promote the improvement of the nurses’ efficiency in health facilities. The evidence should be scientific so as to ensure that good quality healthcare is provided through adequate staffing which reduces the nurses’ workload (Eric, Jamshe & Taler, 2014). It enables the health facilities to have sufficient human resources that will enable them to deliver the best patient care. It will further enable improvement of the working conditions through provision of adequate resources, equipment and support that have been proved to be efficient. This improves efficiency and productivity of the nursing professionals.

Practice change model appropriate for the practice change.

The John Hopkins nursing evidence based practice model would be appropriate for the practice change. It is a scientifically proven approach which provides nurses with problem solving approaches in delivering quality health care. The model identifies factors that need to be addressed including internal and external factors. It identifies guides the nurses in identifying the latest research findings. It further gives guidance on the best practices in the nursing profession. It comprises of use friendly tools that health facilities use as a guideline in making decisions.   The model uses questions, evidence and translation in the nursing professions to determine the latest findings and recommendations in the profession so as to implement them (Eric, Jamshed & Taler, 2014).

How to apply the identified model

The model can be applied to solve the issue on workloads by implementing latest research findings and the best practices that found in the existing literature that has been reviewed from the scientific approaches.  The model is implemented in three steps. The steps are question, evidence and translation. In these steps the practice change is identified and the tools in the model are utilized to address the practice change. The overload for nurse can be addressed through the model by following the steps involved in implementing the model (Golberstein & Gonzales, 2015). The model is implemented by identifying the internal and external factors involved. The recommendations of the most current research findings are then implemented using the tools that are provided by the model. The model addresses quality improvement and clinical expertise and it incorporates it into patient care appropriately.

Barriers to successful implementation of the practice change

Ineffective communication between managers, nurses, physicians and other employees working in the health facility is a barrier to the implementation of the practice change (Koithan, 2014). It affects the coordination of different activities and departments in health facility. Poor coordination of among the stakeholders leads to failure to successfully implement the change. It leads to failure of the employees to work as a team. The lack of cooperation by the management of the health facility can also be a barrier during the implementation of the practice change.  The management must support the change fully for it to be successful. If other staff members do not get support from the management, they lack motivation and this may lead to failure of the change that is being implemented. Lack of resources may also hinder the implementation of change. For the change to be successful, the necessary resources must be provided. For instance, in order to increase the number of nurses, the management needs to avail more money to pay them.

Ethical implications that may come up during planning and implementation of the practice change

During the planning and implementation of the practice change in a health facility, the ethical issue of the confidentiality can be breached. This happens when of patients’ documents and medical information is compromised, especially when there is change in use of technology. Patients’ confidential information might be accessed by the people who are involved in data entry and this goes against the nurse code of ethics. Another ethical issue is that the implementation of change at times cause harm to the patients. Causing harm, either physical or emotional is unethical. Changes that are implemented at times may change the staffing patterns and this may have a negative emotional effect to a patient. For example, when the practice changes require the nurses to work in a different department or section some patients may resist the change to be attended by another nurse. The change can also affect ethics on fairness and equity. Balancing between fairness and equitability when planning and implementing the changes is at times not appreciated by different stakeholders Some may feel that the change is appropriate while others will not appreciate it. This goes against the nurse code of ethics for nurses especially if the patients do not appreciate the change.

In conclusion, the nurses get overwhelmed by the unsafe and unrealistic workloads. High workload among nurses workload leads to low morale, poor job performance, high employee turnover and absenteeism. The poor performance may compromise the care and safety of patients. Higher staffing levels have reduces the mobility and mortality rates of patients. Improvement of the work environment by providing adequate resources, equipment and support motivates the nurses as they perform their duties. It decreases nurse burnout and increases job satisfaction. This reduces the occurrence of errors and employee of turnover and it improves better patient care.

 

 

 

 

 

 

 

 

References

Bell, L. (2015). Code of Ethics for Nurses With Interpretive Statements. Critical Care

Nurse, 35(4), 84-84. doi:10.4037/ccn2015639

Campbell, P. (2013). Nursing Management: Principles and Practice Nursing Management

: Principles and Practice. Nursing Management, 20(3),

9-9. doi:10.7748/nm2013.06.20.3.9.s15

Eric De Jonge, K., Jamshed, N., & Taler, G. (2014). Effects of Nursing on Medicare in

Primary Healthcare. Journal Of The American Geriatrics Society, 74(10), 1905-1910.

Golberstein, E., & Gonzales, G. (2015). The Effects of Medicaid Eligibility on Health

Services and Nursing Health Services. Health Services

Research, 50(6), 1734-1750.

Klein, T. (2013). Regulation of Prescriptive Authority. Brown/The Advanced Practice Registered

 Nurse as a Prescriber: The Advanced Practice Registered Nurse as a Prescriber,

175-200. doi:10.1002/9781118696965.

Koithan, M. (2014). Concepts and Principles of Integrative Nursing. Integrative Nursing,

3-16. doi:10.1093/med/9780199860739.003.0001

Peikes, D., Chen, A., & Brown, R. (2013). Effects of care coordination on

 

hospitalization, quality of care, and health care expenditures among Healthcare

 

beneficiaries: 15 randomized trials. Jama, 312(6), 603-618.

 

Stason, W. B., Ritter, G. A., Martin, T., Prottas, J., Tompkins, C., & Shepard, D. S. (2016).

Effects of Expanded Coverage for Nursing Services on Medicare Costs in a CMS

Demonstration. Plos ONE, 11(2), 1-14. doi:10.1371/journal.pone.0147959