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Significance of Nursing Workload to Nursing

Discuss about the Professional Accountability and Patient Safety for Nursing.

The nursing workload is a professional nursing issue that needs a throughput understanding. Nursing workload refers to the magnitude of work and professional setting that practicing nursing professionals are subjected to given the professional standards of practice (Alghamdi 2016, pp 449-57). Throughput definition of nursing workloads encompasses five dimensions that include the amount of time, nursing competency, work setting, nursing intensity, and professional development. Firstly, the amount of time is the nursing professionals spend offering both direct and indirect care to patients. The nursing setting is characterized by a huge amount of time that is stressful and this affects the health safety.

Secondly, nursing competency is another aspect of nursing practice that clearly describes or explains the nursing workloads (Abbas & Hassan 2017, pp 37-47). Nursing competency can be used to describe the skill, knowledge, and behavior that nursing professional has and use for to care for patients. The nursing workplace requires high professional competency yet nursing practitioners have limited competency that does not match the current complex healthcare situation. Thirdly, nursing intensity also defines nursing workloads since it touches on the amount of care offered to the patient within healthcare. Nursing practitioners offer a wide variety of patient care that is really demanding and this has left many nursing professionals struggling to care beyond their ability. Fourthly, the professional development includes physical activities, mental and emotional developments that help the nurse to be fully developed in the line of the profession (Hunter & Giardino 2007, Issue 13).

Nursing workloads are highly significant in the nursing practice and play role in the nursing profession. Firstly, nursing workloads have a high impact on nursing profession since the workload determines the quality of nursing care. Nursing workloads reduce the quality of care the nursing professional offers to the patient since nursing workload makes the profession stressful. High nursing workload makes number of nursing professionals few as compared to the number of patients (Carayon & Gurses 2005, pp 284–301).

Secondly, the nursing workload is a professional issue since the nursing workload highly affects the nursing profession. Nursing workloads are seen as making many nursing professionals consider leaving the profession for other jobs. This is due to the high workload that makes the whole profession very stressful and uncalled for. In addition, the nursing workload is lowering the quality of the practice offered by nursing practitioners. As a professional issue nursing workload has an effect on the ethical standards that are applied on the practice. For instance, nursing workload makes the quality of healthcare services lower that contradict the ethical requirement of nursing practice (Mellor 2014).

Impact of Nursing Workloads on Patient Safety

Nursing workload has an impact on individual nurse since the issue is making the nursing workplace unsafe for the individual nurse. Nursing workload reduces an individual nurse competency due to the low quality of care offered to the patient. The high amount of time that nurse practitioner spent caring for the patient has a huge impact on the individual nurse and the nursing profession as a whole. The magnitude of nursing workload has an impact on the physical, emotional and mental development of an individual nurse hence increasing exhaustion. Several activities a nurse does at the healthcare increase the fatigue and reducing the performance of individual nurse. Furthermore, workload makes nurse work under intense pressure that is so compelling and this increases the number of nursing practitioner leaving the nursing profession for other jobs. Nursing workloads also make the healthcare environment worse and unattractive for new entrants. Another impact of the negative nursing workload is the negative nursing outcome that so much affects an individual nursing practitioner. The negative nursing care that results from huge nursing workload has a negative impact on the competency of the nursing practitioner (Stanton & Rutherford 2004).

There are statistics and figures that show the effects of nursing workload on the quality of nursing care, patient outcome, and nursing job dissatisfaction. Firstly, one of the issues of concern is the nursing job dissatisfaction that shows more nurses are not satisfied with their nursing profession due to poor working conditions. These poor working conditions is a resultant from high nursing workloads experience at healthcare. Many nurses are on the verge of leaving the nursing profession and the number is worrying. For instance, according to Mellor (2014), 23 % of nurses and midwives were likely to leave the nursing profession in Australia. In addition, more than 33 % of nursing practitioners frequently thought about leaving the profession in Australia (Rogers, Hwang & Scott et al, 2004, pp 202-12).

The impact of the nursing workload on the nursing profession is directly related to patient safety. Nursing workload reduces the patient length of stay since the workload increases the number of nurses required at a particular time. A high number of the patient cannot match the minimal number of nursing practitioners.  This has reduced the number of hours spend with patients, a low number of caregivers and inability to rescue patients from complications (Hunter & Giardino 2007, Issue 13). Low staffing ration between nursing practitioners and patients corresponds to a high number of patients stay in the healthcare. Violation of policies, protocols, and standards is another impact of workload on the patient's safety. Nursing workloads bring more pressure on nurse leading to the low observance of general standards of practice thereby risking the life of patients under their care. For instance, compliance with a clinical protocol or violation of clinical protocol has an immense impact on the clinical patient's outcome. Violation of clinical protocol is associated with worse clinical outcome and this can be attributed to nursing workload. Most protocol violations are due to the workload pressures experienced during emergency situations that are normally demanding for nursing practitioners (Baethge & Rigotti, 2013, pp 43–63).

There are statistics that are showing the adverse effect of nursing workloads on patient’s safety. Firstly, a study conducted in Australia on causing factor for death due to cancer include the nursing workload that has a direct effect on patient care hence death due low nursing care. According to the study, 73% nursing practitioners felt they had inadequate time to incorporate strategies into their existing nursing workload (Carayon & Gurses 2005, pp 284–301). Another study suggests that an increase of 1 hour worked by practicing nurse (PNs) per patient day is directly related to an 8.9 percent chronic decrease outcomes. A retrospective cohort study within neonatal ICU indicates that the incidence of E cloacae infection within the unit was at least higher when there was limited number of nurses. Another example includes a study that used 168 patients and revealed that there is 7% increase in death within 30 days of medication due understaffing of nursing practitioners (Baernholdt et al 2010, pp229-34).

The nursing workloads as an issue of patient safety concern have an adverse consequence on the patient. Firstly, the nursing workload affects the patient outcome and particularly results in the negative patient's outcomes. The negative patient outcome results in the lower quality of nursing care offered due to huge nursing workloads (Cho et al 2003, pp 71–9). Secondly, another adverse effect of nursing workload on a patient includes high mortality rate that is part of the limited time spent on patient care by nursing professional. Studies show that more mortality results from failure to rescue a patient who develops complications due to a limited number of nursing practitioners within high workloads. In addition, using health data obtained from 799 hospitals within 11 States indicates that a higher number of hours of Registered Nursing practitioners care daily were related to lower failure to rescue rates (Aiken, Clarke & Sloane et al. 2002, pp 1987–93).

There are various strategies that can be used to minimize the impact of nursing workloads on nursing practice and patient’s safety. Firstly, interdisciplinary approach to patient cares in one of the strategies to minimize the impact of workload.  The interdisciplinary approach reduces the impact of huge workload that nursing practitioners experience while working. Moreover, the interdisciplinary approach increases the staffing capacity to deal with the patient care. The interdisciplinary approach also helps reduce the amount of time that is required for the nursing office to work in patient care (Gurses 2005).

Secondly, nursing staffing is another strategy that can assist to minimize the impact of workload on nursing practice. Statistics indicate that there are few nursing practitioners in Australia that take care of patients as compared to the number of patients that need the nursing care. This magnitude of work has raised the amount of work left in the hand of these nursing practitioners. Increasing the number of nursing staffs in various health care throughout Australia would reduce the nursing workload and reduce the impact of nursing workload on patients safety (Kondro 2004, p2059).  

Nursing education framework is another important strategy as it seeks to improve the nursing skills and knowledge. Nursing education has been an issue of concern particularly when it comes to the nursing workloads. One of the aspects of nursing workload includes lack of skills and knowledge that can match the current health care requirement. This can be rectified through the development of nursing education framework that provides an avenue for nursing practitioners to further their education with updates on development in the nursing profession. Nursing education moreover, has the capability of changing current nursing challenges that are contributing to nursing workloads (Duffield 2006, Pp 16-22).

Application of modern information technology is another strategy that can be used to reduce the impact of nursing workload on patient safety and nursing practice. According to Ferguson-Pare and Bandurchin (2010, pp20-32), patient records can be computerized as a way to maintain the amount of work nursing practitioners required to perform. This also helps in monitoring the patient's progress and outcomes from any place through electronic means. The current information technologies make monitoring of patient care easy provided that all the information is registered into the system. For instance, the Royal Australian College of General Practitioners indicates that the use of Practicing Nurse system to monitor health records projecting to have an impact on the nursing workload (The Royal Australian College of General Practitioners, 2018).

Conclusion

In conclusion, the nursing workload is an important nursing professional issue that affects many nursing practitioners and healthcare facilities in Australia. The nursing workload can be defined in terms of intensity of nursing, amount of time spent on patient care and physical, emotional and mental development. Understaffing which is part of nursing workload is correlated to patient safety concerns as it results in low patient care. In addition, the nursing workload has an adverse effect on both nursing profession and patient safety. 

References

Aiken, LJ, Clarke, SP, & Sloane, DM, et al. 2002, Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, Vol.288, no.16, pp 1987–93.

Alghamdi, MG, 2016, Nursing workload: a concept analysis. Journal of Nursing Management, vol.24, no.4, pp 449-57.

Abbas H, & Hassan, S, 2017, The workload of nursing: A concept analysis using a walker and avant approach. Journal of Clinical Nursing and Midwifery, Vol.4, no.3, pp 37-47

Baethge, A.; & Rigotti, T. 2013, Interruptions to workflow: Their relationship with irritation and satisfaction with performance, and the mediating roles of time pressure and mental demands. Work Stress, vol.27, pp 43–63.

Baernholdt, M, et al 2010, Using Clinical Data to Capture Nurse Workload. CIN: July/Aug, Vol 28, no4; pp229-34.

Carayon P, & Gurses A, 2005, Nursing workload and patient safety in intensive care units: a human factors engineering evaluation of the literature. Intensive Crit Care Nurs, vol.21, pp 284–301.

Cho SH, et al. 2003, The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Nurs Res. Vol.52, no.2, pp 71–9.

Duffield, C, 2006, Methods of measuring nursing workload in Australia. Collegian, Vol.13, Issue 1, Pp 16-22

Ferguson-Pare, M, & Bandurchin, A, 2010, The Ontario Nursing Workload Demonstration Projects: Rethinking How We Measure, Cost and Plan the Work of Nurses. Nursing Leadership, Vol 23, special issue, pp20-32.

Gurses AP, 2005, ICU nursing workload: causes and consequences—final report. Rockville, MD: Agency for Healthcare Research and Quality. Available at: https://hfrp?.umaryland?.edu/People/gurses_AHRQ?_final_report-06-15-05.pdf.

Hunter, K, & Giardino, I 2007, A Question of Patient Safety. Health Canada Health Policy Research Bulletin, Issue 13.

Kondro, W, 2004, Canadian report quantifies cost of medical errors. Lancet, vol.363 no.9426, p2059.

Mellor, L, 2014, Nurse workloads a key factor in rising patient deaths. Available at: https://www.abc.net.au/news/2014-12-03/nurse-workloads-a-critical-factor-in-patient-survival-rates/5937224

Rogers, A, Hwang, W, & Scott, L et al, 2004, The working hours of hospital staff nurses and patient safety. Health Affairs, vol.23, no.4, pp 202-12.

Stanton, MW, & Rutherford, MK, 2004, Hospital nurse staffing and quality of care. Rockville, MD: Agency for Healthcare Research and Quality;. AHRQ Pub No 04–0029.

The Royal Australian College of General Practitioners, 2018, Practice nurses: Putting prevention into practice (Green Book). Accessible at: https://www.racgp.org.au/your-practice/guidelines/greenbook/a-framework-for-prevention-in-general-practice/key-strategies-for-improved-prevention-performance/practice-nurses/

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