The Need for Policies to Improve a Healthier Nursing Workforce

Published: 2021-07-07 01:55:05
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Category: Nurse

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According to the Gallup survey done in December 2017, the poll reveals that nursing is one of the most trusted professions in the United States. 82% of respondents believe nurses have high or very high honesty and ethical standards. Nurses work to identify, promote, protect, and optimize the health and well-being of their patients. Nurses require a certain set of traits and skills in order to be successful; traits such as compassion and dedication with listening, communication, and critical thinking skills being very important as well. Nurses also need patience, not only with their patient, but with time as their shifts can be more than 12 hours; that requires stamina to endure the long shifts which can often be very taxing, both mentally and physically. The traditional 8 hour shift for hospital nurses are starting to become a thing of the past as nurses are increasingly working 12 hour shifts. This schedule gives nurses the flexibility of having a three day work week instead of a five day work week, potentially providing better work-life balance. However, actual shift lengths can be unpredictable as a result of variations in patient needs and unforeseen staffing changes. Because of this, nurses sometimes must put in unplanned overtime. With long shifts that sometimes have an added overtime, shifts that rotate between day and night duty, and consecutive shifts, nurses are at risk for fatigue and burnout, which can compromise patient care.
A group of researchers at the University of Pennsylvania conducted a secondary analysis of 2,275 RNs, from 577 hospitals in four states. The data presented that 65% of the nurses had most recently worked a 12 or 13 hour shift. As shift length, increased so did the percentage of nurses reporting burnout and the intention to leave their current job. They found the odds of burnout and job dissatisfaction were 2.5 times higher for nurses who worked longer shifts when compared with nurses who worked 8 or 9 hours. Additionally, a study conducted by the Pennsylvania Patient Safety Reporting System showed working a 12 hour shift or working overtime was associated with having trouble staying awake during the shift, reduced sleep times and nearly three times the risk of making an error. The study also indicated the most significant error risk identified was when the nurses worked 12.5 hours or longer. They also found that there was a significant association with patient satisfaction and hours worked. When nurses worked 13 or more hours, patients were less happy and less likely to recommend the hospital to others. Furthermore, they also reported that nurses rarely communicated well, pain was rarely well controlled, and they rarely received help as soon as they wanted. The results suggest that patients receive worse care in hospitals that have a high amount of nurses working shifts of more than 13 hours. In terms of future policy development, in 2011 a “sentinel event” alert was issued by the Joint Commission. It called for hospitals to increase their efforts to monitor and address health care workers’ risk for fatigue caused by long shifts. The Joint Commission made recommendations, but it was ultimately up to hospitals to manage and implement changes. There are currently regulations on shift length and total hours worked for resident physicians and people in other industries, but none for RNs. Several states, such as Maryland and California, have restricted mandatory overtime for nurses, however, there is no limit to voluntary overtime hours.A workplace culture that respects nurses’ days off, promotes their timely departure at the end of a scheduled shift, and allows nurses to refuse to work overtime without fear of consequences should be encouraged. Meals and break times should be enforced as well. Working long hours has a profound effect on nurses and patients. These types of policies that promote feasible work hours can contribute to the improvement of a healthier nursing workforce, ready to manage the care and needs of patients.

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