Nurse staffing is one of the most burning issues in the system of healthcare. When taking a closer look at the problem, it is clear that there are several major factors associated with nurse staffing. There is a lack of nursing professionals and nurses are overloaded with tasks. Clearly, this workload leads to burnout, fatigue and dissatisfaction with work (Cimiotti, Aiken, Sloane & Wu, 2012). Of course, these factors, in their turn, tend to result in numerous medic errors and significant personnel turnover.
Another contributor to inadequate nurse staffing is employing unqualified nurses. It has been acknowledged that only an insignificant rate of nursing professionals have bachelor’s or master’s degrees and it has been proved that nurses with degrees and sufficient experience make fewer mistakes, which leads to a faster healing process and lower mortality rate in patients (Cimiotti et al., 2012). Finally, diversity issues are also quite urgent since nursing professionals are often unable to satisfy patients’ needs, as there is a cultural and often linguistic gap.
The practical inquiry theory can be employed to address the issue in question. When applying this middle-range theory, the researcher will be able to identify particular reasons for inappropriate nurse staffing in every particular healthcare facility. Discussions can be seen as primary tools of the theory and, hence, a number of solutions can be developed during such sessions (Stevenson, 2005). Nurses will share their experiences and problems and will be able to come up with ideas to solve some of the most urgent issues. Human resources professionals, as well as healthcare managers, should also participate in the discussion, as this will widen the scope of the issue and researchers will be able to analyze all aspects of the problem.
A Borrowed Theory That Can Be Applied
Apart from the middle-range theory mentioned above, it is possible to utilize a borrowed theory. The theory of planned behavior can be applied to effectively solve nurse-staffing issues. The theory of planned behavior (TPB) involves the focus on two major concepts: “social factor called subjective norm and an added variable which is the degree of perceived behavioral control” (Mutuli & Walingo, 2014, p. 259). In other words, people shape their behavior as they want to comply with a particular behavioral norm (external social factor), but they also have certain limitations as their behavior is controlled by certain factors. Importantly, TPB focuses on situations when people do not have complete control over their behavior, which is the case when it comes to nurse staffing.
There are high chances that the use of this theory can have numerous positive effects on nurse staffing. Thus, it is essential to launch a far-reaching debate involving the management of healthcare facilities, HR professionals, researchers and nursing professionals. Researchers should stress the benefits of proper nurse staffing strategies that have already been developed. Some of the significant factors that prevent healthcare facilities’ management to implement proper nurse staffing are the lack of knowledge and the lack of resources.
However, if the public focuses on the need to improve services provided by nursing professionals, the management of healthcare facilities will have the intention to meet this requirement (external social factor). Irrespective of existing limits (limited control over behavior), which are associated with the lack of resources, the management will prioritize in a way to shape their behavior and solve issues associated with nurse staffing. Therefore, the theory of planned behavior can be the necessary tool to solve the issue in question.
A Brief History of the Theory of Planned Behavior
The theory of planned behavior is an extension of another borrowed theory, Theory of Reasoned Action. Both theories were developed by social psychologists who focused on disorders prevention (Villarruel, Bishop, Simpson, Jemmott & Fawcett, 2001). Clearly, the focus was made on shaping undesirable behaviors. The theory were developed in the 1980s. TPB proved to be effective in many settings and nursing professionals soon borrowed the theory to shape various behaviors of patients. It is possible to think of various ways to use the theory in nursing. The use of certain medication, disease prevention, promotion of lifestyle patterns as well as promotion of self-care can be seen as major fields where the theory can be effectively applied.
Previous Applications of the Theory of Planned Behavior
Some of the well-known examples of the use of TPB is shaping attitudes and behaviors associated with optimal breast-feeding. As has been mentioned above, the theory was first used in diseases prevention. The use of TPB expanded to other spheres as well. For instance, in African countries, nurses encouraged women to breastfeed their newborn babies. Several surveys have been implemented and it has been acknowledged that there is a positive shift when the theory was applied (Mutuli & Walingo, 2014). Women mainly changed their attitude and started breastfeeding during longer periods. Mutuli and Walingo (2014) completed a comprehensive research that involved development of the necessary social factor and special attention was paid to control over the participants’ behavior.
Hence, women were told about benefits and importance of optimal breastfeeding. Nurses promoted this practice and, in that way, they created the social factor that encouraged women to shape their behavior. At the same time, Mutuli and Walingo (2014, p. 260) noted that there were significant concerns that the participants could “lack complete volitional control over the behavior”. Therefore, nursing professionals explained to women that the practice is possible and they can easily handle it. According to the results of the research, the participants’ confidence increased significantly and they changed their behavior.
Application of TPB to the Problem of Nurse Staffing
As has been mentioned above, the borrowed theory can be effectively applied to the problem identified. Thus, it is important to pay attention to two major aspects of the issue. First, there should be strong social factors. Hence, researchers, healthcare professionals (especially nurses) and officials as well as all people involved should start a wide debate on nurse staffing and potential hazards associated with improper nurse staffing. This debate should include discussions in healthcare facilities, conferences involving professionals from different fields, law enforcement and so on. Clearly, it is essential to obtain a wide media coverage to reach more stakeholders. Hence, Americans should understand that nursing professionals provide important services and nurse staffing is an important issue that should be solved as soon as possible. Importantly, discussions should take place on different levels (from healthcare facilities to the Congress). These far-reaching social factors will affect healthcare facilities’ management to pay more attention to the problem and implement the change.
The other important aspect to pay attention to is control over behavior. Admittedly, healthcare managers face numerous challenges such as the lack of resources, the lack of knowledge on the matter, the lack of support and so on. These challenges make healthcare managers feel unconfident as to their ability to implement the change. They often choose to focus on other things as they do not understand the importance of the issue (since they think other issues are much more important).
Therefore, it is crucial to start launching pilot programs in particular healthcare facilities and certain states. There can be no doubt that these projects will be successful and this experience will encourage healthcare managers to implement the change. Of course, the results of the programs have to be publicizes as all stakeholders should see benefits as well as downsides if any of the projects. This will enable healthcare managers to develop strategies that will be effective in particular settings.
Besides, the staff of each healthcare facility can also try to develop certain methods to solve the issues concerning nurse staffing. Thus, the discussion may involve all stakeholders and particular plans can be developed to address the most urgent issues associated with nurse staffing. Of course, successful experience of healthcare facilities have to be analyzed and other facilities and healthcare managers can try to implement the change with the use of some strategies already efficiently utilized.
Application of the Borrowed and the Middle-Range Theories
It is possible to note that the two theories mentioned above can be employed to address the issue. At that, it is important to stress that application of one of the theories will address only one aspect of the issue while the use of both theories may help develop a comprehensive strategy. Hence, the use of the practical inquiry theory will help the stakeholders identify particular issues each healthcare facility (as well the system of the US healthcare) faces. Therefore, the use of this theory will be the first stage.
Researchers and human resources managers will play the most active role at this stage. These people will launch discussions and they will try to identify major causes and effects as well as peculiarities of nurse staffing problems. The data should be analyzed carefully and the results of surveys and different researches should be known to the public. Free online access to numerous works is crucial, as all stakeholders should be able to benefit from the latest developments in the field.
The second stage is the application of the borrowed theory. As has been mentioned above, this theory presupposes two stages. The first one is closely connected with application of the practical inquiry theory. The social factor necessary for the change of behavior will be created through the spread of data on research in the field. Researchers, nursing professionals and official should play the most active part in this process. People should understand the need to develop and utilize effective nurse staffing strategies. Clearly, data on hazards (higher rate of mortality, slower healing processes and so on) can be seen as central as they stress the importance of effective nurse staffing.
Finally, healthcare managers should be confident they will be able to change the situation and use efficient nurse staffing strategies. To achieve this goal, it is important to reveal information on successful implementation of particular strategies in healthcare facilities. Of course, nursing professionals should also be encouraged to launch discussions and implement the change.
In conclusion, it is possible to note that application of the middle-range and borrowed theories can help healthcare professionals solve a serious issue. The middle-range theory will provide the necessary background and the borrowed theory will facilitate the change.
Cimiotti, J.P., Aiken, L.H., Sloane, D.M., Wu, E.S. (2012). Nurse staffing, burnout, and healthcare–associated infection. American Journal of Infection Control, 40, 486-490.
Mutuli, L.A., & Walingo, M.K. (2014). Applicability of theory of planned behavior in understanding breastfeeding intention of postpartum women. International Journal of Multidisciplinary and Current Research, 2, 258-266.
Stevenson, C. (2005). Practical inquiry/theory in nursing. Journal of Advanced Nursing, 50(2), 196-203.
Villarruel, A.M., Bishop, T.L., Simpson, E.M., Jemmott, L.S. & Fawcett, J. (2001). Borrowed theories, shared theories, and the advancement of nursing knowledge. Nursing Science Quarterly, 14(2), 158-163.