Introduction
Staffing has always been an important issue in nursing practice. Inappropriate staffing methods affect many people negatively (Marguis & Huston, 2012). For instance, they threaten the safety and health of patients and increase the complexity of patient care. Improper staffing also poses a negative impact on the safety and health of registered nurses by enhancing their pressure, exhaustion, injuries as well as ability to offer safe patient care. In the United States, nurses are forced to work overtime as a way of compensating for the nursing shortage (Marguis & Huston, 2012). This practice is risky, partly because it equally has some negative effects on patient care, increases medical errors, and does not encourage nurses to actively participate in inpatient care. The main problem is therefore understaffing of nurses in health care centers and associated consequences such as fatigue, working overtime, and delivering inappropriate services to patients.
Research Synthesis
High-quality health services call for skilled management
Berry and Curry (2012) defined leadership as the aspect of motivating team members toward a common goal, and management helps in executing this task. According to the authors, there is a relationship between quality management and such outcomes as better patient care, the clinical outcome as well as fewer patient complaints. Regarding the issue of understaffing, nursing turnover, and related effects such as absenteeism, fatigue, and exhaustion, Berry and Curry held that only by addressing these factors the work-life of nurses and patient care quality can be improved. The authors also touched upon the medication errors resulting from the nursing workload. They also gave significant evidence indicating that improved nurse staffing, as well as working hours, minimize medication errors.
Leadership and responsive care
Bae (2012) indicated that nurses and all nursing staff should always lead by example and not just develop their skills, but also influence the way patient care is offered, i.e. in a manner that is transparent and responsive to the needs of patients. In the case of the nursing shortage, Bae agreed that the idea of overtime work should be adopted by nurses. She also examined the main reasons why nurses worked overtime and their working conditions. Bae assessed them including such factors as the number of patients attended to, nursing shortages on nursing units, the total number of hours worked and employing new staff to help reduce the burden.
Responsibility for all
Patterson (2011) highlights the risk in overlooking the individual responsibility, indicating that good practice can actually be damaged or destroyed by people who do not see that they can apply or exercise leadership. In addition, such people can even leave things undone just because the responsibility lies on someone else. The author established that a low level of staff motivation is associated with adverse events and increases patient mortality. This results from the situation that the existing nurses are few and they do not want to find the best ways of serving patients better. In addition, the study established that understaffed nurses were up to about 90 percent likely to be unhappy about their jobs, which leads to deteriorated quality of patient care.
Separation of staff from the management
The Royal College of Nursing (2013) Indicated that in a health center in which the staff is separated from the management; there is usually a high level of confusion amongst staff at all levels, which negatively affects patient care. In such situations, no one takes charge or accountability for managing the work. According to the authors, in such cases, it is easier to find medical practitioners leaving patients uncared for, just because there is a lack of enough staff. Accordingly, these factors are a major hindrance to the retention of nurses. In the end, it leads to compromised quality of patient care in health care centers. As the Royal College of Nursing indicated, shortages in nursing staff denote that nurses are commonly working overtime in order to cover for the missing staff.
Leadership Framework
According to Harris and Hall (2012), the Leadership Framework ensures that employees have the desired leadership knowledge. The authors held that managers of care should not be viewed as just administrators who are only concerned with filling of forms. They indicated that being viewed this way lowers the morale of staff and also restrains the engagement of medical practitioners with management roles. The authors indicated that management in nursing also entails the knowledge of delivery models of nursing care and providing some support necessary to capture other issues of patient care, including continuity and communication. Particularly, this aspect is vital provided that the current models of patient care emphasize optimizing the effectiveness of deploying health care workers. This is based on the fact that conventional models of delivering care to patients, such as functional nursing and primary nursing, seem to have some mixed impacts on both medical practitioners and patient outcomes, thus emphasizing the significance of the target population and environment.
Recommendations
The Leadership Framework that reflects a management framework could be useful in enabling all medical staff to attain the management behavior necessary for providing decent patient care. A part of this could be obtained from the Leadership Framework, particularly the part on managing health care services (Bae, 2012). In terms of organizational level recommendations, health institutions should develop processes that will help in documenting fatigue and working overtime in relation to patient errors and staff retention (Harris & Hall, 2012). Health care facilities should also be equipped with sleep facilities to help nurses, particularly those of night shifts, minimize circadian disruptions.
Leadership Framework in nursing helps in bringing together best practices of guidance and leadership principles (Harris & Hall, 2012). The resultant framework would provide a reliable approach to leadership development of nursing staff irrespective of the roles and positions they hold. In terms of individual-level recommendations, nurses should understand and even work within the set policies, especially those relating to the safety of patients. In addition, nurses should take responsibility for managing and mitigating fatigue while at work (Patterson, 2011).
Conclusion
Nurse staffing has always been a problem in many countries. As it has been established, when nurses are fewer, they tend to be overwhelmed with responsibilities, which leads to fatigue and dissatisfaction. Eventually, they create medical errors which put the health of patients at risk. This issue can be mitigated by ensuring that sufficient funding is provided to train enough staff to help in the provision of appropriate patient care. In addition, it has been recommended that sleep facilities be set up to help nurses avoid sleep complications arising from sleepless nights.
References
Bae, S. (2012). Nursing Overtime: Why, How Much, and Under What Working Conditions? Nursing Economics, 30 (2), 60-72.
Berry, L., & Curry, P. (2012). Nursing Workload and Patient Care. The Canadian Federation of Nurses Unions, 2 (1), 1-98.
Harris, A., & Hall, L. (2012). Evidence to Inform Staff Mix Decision making: A Focused Literature Review. The Canadian Nurses Association, 4 (2), 1-50.
Marguis, B., & Huston, c. (2012). Leadership Roles and management functions in Nursing: Theory application (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Patterson, J. (2011). The effects of nurse to patient ratios. Nursing Times, 107 (2), 22-26.
The Royal College of Nursing. (2013). Royal College of Nursing Evidence to the NHS Pay Review Body. NHS Pay Review Body, 2 (1), 1-21.