The Nursing Shortage and the Nursing Work Environment Essay Example for Free

The Nursing Shortage and the Nursing Work Environment Essay 1. Introduction 1.1 Nursing as challenging profession: significant physical and psychological demands on nurses of all levels 1.2 Qualified nurses as the core key to success in the delivery of healthcare services 1.3 Qualified nursing staff, hospitals, clinics, nursing homes, and other essential healthcare services as contribution to modern world Problem Statement 2.1 The current situation with shortage of qualified nurses in the USA 2.2 The year of 2004: the positive shifts in dealing with nursing shortage 2.3 Population aging and retiring nurses as the main reason of severe nursing shortage Research Question 3.1 The impact of job-related stress on health care organizations and qualified nurses 3.2 Measures to be taken to alleviate job-related stress for nurses 3.3 Reduction of job-related stress as the solution to nursing shortage Research Hypotheses 4.1 Hypothesis 1: Nurses will indicate that they experience job-related stress. 4.2 Hypothesis 2: Job-related stress is a factor in a nurses decision to leave nursing. 4.3 Hypothesis 3: Nurses who have learned to manage their stress will be more likely to continue their careers. Literature Review Job-related stress may have serious implications for patient safety. Increased patient loads, for example, have been associated with elevated stress levels, the increased likelihood of an accident, and a greater risk of the nurse being involved in a medical malpractice lawsuit (Miller, 2004). One study found that 79% of RNs believed that the shortage of qualified nurses has already affected the quality of patient care (Buerhaus,   Donelan,   Ulrich,   Linda Norman,   et al, 2005). Although some studies have found that stress levels may be affected by the mode of nursing, other research has indicated similar levels of stress in functional nursing, team nursing, and primary nursing settings (Mà ¤kinen, Kivimà ¤ki, Elovainio, Virtanen, Bond, 2003). Sources of Stress Stress in nursing comes from physical and mental exertion while working with patients and the emotional stress that comes from dealing with injured, sick, and dying people. Job stress may also affected by staff reductions, especially if those reductions result in increased responsibilities for the remaining staff members (Hertting, Nilsson, Theorell, Larsson, 2004, p. 148). The long-term effects of staff reductions include feelings of distrust towards the employer; (2) concurrent demands and challenges; (3) professional ambiguity; (4) unmet desires for collaboration with other professionals; and (5) efforts to gain control (Hertting, Nilsson, Theorell, Larsson, p. 148) For many nurses, some job-related stress may come from internal sources. Antai-Otong (2001) observed that one pervasive cause of stress among nurses is the feeling that nurses must do everything for everyone all of the time and be perfect while doing it. These unrealistic expectations for perfection may lead to chronic anger, hostility, or repressed aggression, especially if the individual lacks sufficient coping skills to address these emotions (Antai-Otong). To cope with this stress, Antai-Otong recommended that nurses receive training in conflict management, anger management, self-renewal techniques, assertive communication, and other forms of creative stress management. Finally, stress also appears to be affected by age and experience. In studies comparing stress and job satisfaction of older nurses with that of younger nurses, older nurses with more years experience showed less stress and reported more positive experiences as a nurse than their younger counterparts (Ernst, Messmer, Franco, Gonzalez, 2004). Younger nurses reported concerns over compensation, workload, and lack of recognition (Ernst, et al). Ernst, et al., (p. 222) speculated that older nurses had less reason to be worried about income than their younger counterparts because the older nurses were paid more. They also speculated that the expectations and goals of the nurses in the study had become more realistic as they matured, resulting in greater job satisfaction (Ernst, et al., p. 225). Providing Ways to Improve Retention Incentives may be used to motivate nurses to improve their performance or to stay with an employer. Incentives do not necessarily have to be monetary. In some cases, non-monetary incentives such as the opportunity to work in a positive work environment may outweigh relatively small financial incentives. Other incentives that may be used to encourage nurses to stay are educational opportunities, flexible scheduling, health and safety considerations, and the nature of the overall organizational culture (Cohen, 2006). Many nurses are concerned with the balance of their professional and personal responsibilities. Quality of work life (QWL) has been defined as the balance between the individuals professional responsibilities and personal life (Ming-Yi Kernohan, 2006). QWL has been linked to job satisfaction and improved retention. Factors that affect the QWL of nurses include socioeconomic factors, demographic characteristics of the individual nurse (e.g., age, marital status, and other personal characteristics), organizational aspects, work aspects, human relation aspects, and the opportunity for self-actualization through nursing (Ming-Yi Kernohan). Of these, the individuals demographic characteristics and the socioeconomic status of the health care facility and the surrounding area are beyond the control of the organization. Other factors, such as providing opportunities for self-actualization, may be affected by organizational policies but are not exclusively within the domain of the organization. The remaining factors – organizational aspects, work aspects, and human relations aspects – are within the control of the organization. Organizations that wish to improve their retention rates for high-performing nurses may wish to examine how these factors can be adjusted to improve the QWL of nurses working within the organization. Lambert, Lambert, and Yamase (2004) noted that stress is often associated with uncertainty and a lack of information. Providing nurses with information, training, and continuing education can help alleviate these feelings and may help to reduce the overall levels of stress. Lambert, at al. also recommends exercise, physical exertion, and expressing feelings to an inanimate object as appropriate stress-reduction techniques. Environmental changes, such as brightening the environment with flowers and other aesthetically appealing items, may also help reduce the stress levels in the workplace (Lamber, et al.). Finally, Lambert, et al. suggested searching for any possible philosophical or spiritual implications that might help the individual to understand and to cope with the stresses that come along with patient care. Conclusion There is a strong reciprocal relationship between job stress and nurse retention. As nurses within a given facility begin to experience increased stress, the likelihood that some will quit or look for a job elsewhere appears to increase. Consequently, the work loads of the remaining nurses increase, which ratchets up the stress levels, resulting in more nurses leaving the organization. This cycle is not limited to organizations, but also appears to occur within the nursing profession. References Antai-Otong, D. (2001). Creative Stress-Management Techniques For Self-Renewal. Dermatology Nursing, 13, 1, 31-37. Retrieved July 27, 2007, from Academic Search Premier Database. Beaudoin, L., Edgar, L. (2003). Hassles: Their Importance to Nurses Quality of Work Life.   Nursing Economic$, 21, 3, 106-114. Retrieved July 26, 2007, from Academic Search Premier Database. Buerhaus, P., Donelan, K., Ulrich, B., Norman, L., Williams, M., Dittus, R. (2005). Hospital RNs and CNOs Perceptions of the Impact of the Nursing Shortage on the Quality of Care. Nursing Economics, 23, 5, 214-221. Retrieved July 27, 2007, from ProQuest Database Cohen, J. (2006). The Aging Nursing Workforce: How to Retain Experienced Nurses. Journal of Healthcare Management, 51, 4, 233-245. Retrieved July 27, 2007, from Academic Search Premier. Ernst, M., Messmer, P., Franco, M., Gonzalez, J. (2004). Nurses Job Satisfaction, Stress, and Recognition in a Pediatric Setting. Pediatric Nursing, 30, 3, 219-227. Retrieved July 27, 2007, from Academic Search Premier Database. Hertting, A., Nilsson, K., Theorell, T., Larsson, U. (2004). Downsizing and Reorganization: Demands, Challenges, and Ambiguity for Registered Nurses. Journal of Advanced Nursing, 45, 2, 145-154. Retrieved July 27, 2007, from Academic Search Premier Database. Lambert, V., Lambert, C., Yamase, H. (2004). Psychological Hardiness, Workplace Stress and Related Stress Reduction Strategies. Nursing Health Sciences, 5, 2, 181-183. Retrieved July 27, 2007, from Academic Search Premier Database. Mà ¤kinen, A., Kivimà ¤ki M., Elovainio, M., Virtanen, M. Bond, S. (2003). Organization of Nursing Care As a Determinant of Job Satisfaction Among Hospital Nurses.   Journal of nursing management, 11, 5, 299-306. Retrieved July 27, 2007, from Academic Search Premier Database. Miller, D. (2004). Where Have All the Nurses Gone? The Impact of the Nursing Shortage on American Healthcare. Association of Operating Room Nurses. AORN Journal, 80, 1, 141. Retrieved July 27, 2007, from ProQuest Database. Ming-Yi H., Kernohan, G. (2006). Dimensions of Hospital Nurses’ Quality of Working Life.   Journal of Advanced Nursing, 54, 1, 120-131. Retrieved July 27, 2007, from Academic Search Premier. U.S. Department of Health and Human Services (2002). Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, National Center for Health Workforce Analysis. Retrieved July 27, 2007, from http://www.ahca.org/research/rnsupply_demand.pdf U.S. Department of Health and Human Services (2004). The Registered Nurse Population. Findings from the March 2004 National Sample Survey of Registered Nurses. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions. Retrieved July 27, 2007, from ftp://ftp.hrsa.gov/bhpr/workforce/0306rnss.pdf