peer respondse

Peer Review Worksheet

PEER REVIEW ASSIGNMENT-Part I

Using the guidelines below, provide feedback to your assigned peers (10 points):

The goal for your responses should be to provide the writer with clear, specific possibilities for revision.Focus your attention on the content and structure of the paper, not the grammar.Your job is not to edit your groupmates’ work for grammar mistakes.If you notice a lot of problems with grammar/punctuation, definitely mention this, but don’t make this the focus of your review. Please provide thorough feedback for each question to receive credit for this assignment.

Guidelines for peer review:

• What is the purpose statement of the paper? If there is not a purpose statement, can you identify the purpose of the paper? What is the purpose?
• What is the author’s position on this nursing topic?
• How does the introduction, background, and explanation of the nursing topic help define the purpose of the paper? (Hint: Explain if the author is introducing a problem, supporting current practice, or proposing a new practice. Discuss if the introduction caught your attention and why. Explain how the background helped you understand the evolution of the issue and how the key terms/points of the issue defined the purpose). Don’t be afraid to state that you do not understand the issue, ask questions to improve your understanding, or suggest ways to clarify this section of the paper.
• What is your understanding of this author’s paper at this point? (Ex: The author believes that patient-to-nurse ratios should be based on acuity of the patient load. The background information related to this topic shows that patient outcomes have suffered when nurses care for too many very ill patients. Key terms for this issue are: patient acuity, patient-to-nurse ratio, patient satisfaction, nurse satisfaction, improved patient outcomes. He will present literature to support his position and will use a case study to further illustrate his position.)

Pay attention to organization.Make note of any sentence that seems out of place, and any transition from one idea to another that seems abrupt or confusing.Hint: Indicate if the paper “flows” and whether ideas build on each other.

Pay attention to clarity.Discuss whether ideas are expressed clearly. Don’t be afraid to ask questions if needed to help the author better explain a concept. See the suggestions below, if needed.

• Ask questions: In many cases, the best feedback you can offer comes in the form of questions.Here are some examples (you don’t have to use any of these—I only offer them as a handful of sample questions).
• Show where the writer could provide more information: An effective approach would be to ask for more information and to explain why you think the information would be helpful:

Why do you wait until the 4th page to begin talking about ___________ ?

What does _____________ mean in the context of _____________?

Why is ______________ important?

Think about the journalistic questions: Who? What? When? Where? How?

I would like to know more about . . . because . . .

The first one

Introduction

While some professions have their employees spend all of their time doing their job in a cubicle, the same cannot be said about nurses. Nurses spend the majority of their time in direst patient care. Not only is a nurse’s job physically demanding, it requires team work with other nurses to complete task. Nurses rely on each other to verify facts, work place policies, and to help each other complete task during their shifts. Nurses are not working just to help patients; they are there to help each other. Unfortunately, nurses cannot provide the care they need to when they work understaffed. Not only does it become extremely hard to perform task that are required, i.e. patient’s needs, but you have less resources to help you during your shifts. This can lead to seriously frustrated nurses, and we see many new nurses not being able to cope with these working conditions, and leave the field completely in their early career. Not just new nurses are leaving the field though. Over 33% of nurses leave the field within just two years of starting, that is almost double the amount of new nurses that leave the field within the first year, which is 17.5% (“One in Five Nurses Leave First Job Within a Year”, 2019).These are shocking numbers, but frankly, people cannot work under such stressful conditions without having the proper staff. The nursing field changes constantly. Not only are their medical advances every day, but the role of the nurse changes. Our list of task and required charting grows every day; and that doesn’t even include the time we spend taking care of our patients and their family. The amount of work can be daunting not only to new staff, but also nurses who have been working in the field for a while, especially when there is not enough help. The frustration that comes with working understaffed affects nurses of all ages and ones with all different levels of experience. With frustration levels rising, we see nurses all across the US leaving the field early for different careers, retiring, or finding nursing jobs that allow them to work from home, or leaving direct patient care. Not only are nurse leaving the field early due to frustrations, the majority of the nursing field continues to be a majority female run profession, and mostly during their childbearing years; so nurses will cut back their hours or quit altogether to raise their families according to Haddad and Toney-Butler, (2019). Nurses that work understaffed do not feel safe, they do not feel like they are taking care of patients properly, and they are not satisfied at their jobs. The purpose of this paper is to evaluate the impact that understaffing has on nursing turnover, discuss research related to understaffing in hospital settings, the results understaffing has on nurses and hospital units, and frustrations nurses feel working on the floor during understaffed shifts.

Background

The issue of nursing shortages is not a new problem. We have seen a shortage of nurses since the mid 1930’s. During the Great Depression, nursing jobs were hard to come by, as were all jobs, and hospitals found themselves able to easily have enough employees, people were desperate for jobs. The beginning of the shortage came about with World War II. By the end of the war, more than 77,000 nurses had signed up for military services and in doing so the removed “what was then about 25 percent of the nurse population for the war effort severely compromised the nursing needs of the civilian population” (“Where Did All the Nurses Go?”). We are nearing on a decade in our country that nursing shortages have been an issue. Time has not seen positive changes, and “The number of nurses leaving the workforce each year has been growing steadily from around 40,000 in 2010 to nearly 80,000 by 2020” (Anonymous, 2019). Being slightly understaffed does not always create a working environment that causes people to leave; it can have benefits that draw people to want to work on that particular unit. This creates opportunity for overtime, and this is something that employees in a lot of fields look for when taking a job; the prospect for extra money to help pay off student loans, or come holiday times, is something many people rely on. But missing one or two nurses a shift a few times a week is different than being down 2-3 nurses each shift every day. There is a definitive line between having opportunity for overtime, and having the nurse do enough work for two people due to being understaffed.

Explanation of the Nursing Issue

High rates of turnover in the medical field have costly results, and is detrimental to workers and patients. Working short leads to frustration, and the loss of nurses who are experienced and competent. According to a study done in 2014 of 242 nurses in Ethiopia, “recruitment, retention, turnover, and development of quality care in nursing are global issues” (Asegid, 2014). We see this is a problem everywhere, not just America. There are many factors that play a role in retaining nurses. These include: group cohesion, job stress, work satisfaction, and work schedule (Asegid, 2014). The study also defines job satisfaction as “the fulfillment, gratification, and enjoyment that comes from work”.There are many things that play into job satisfaction, it is not just our job as nurses to have the mental capacity to always be happy and satisfied in every situation we are in. Our relationships with others at work, being recognized for a job well done, autonomy, and opportunity for advancement are all something we look for in our jobs to be satisfied. These things are important to us and our coworkers. From an administrative standpoint, looking at the cost of nursing turnover, it cost a hospital much more to recruit and train new nurses that it does to keep the ones they already have. Nurses are looking for support from their leaders; we want to be heard when voicing concerns about staffing and other issues that affect our work environment. When a nurse sees the pattern of being understaffed, and come to a realization that it is not changing, there is a deep internal discussion that takes places; and the nurse has to decide if they can continue to work under those conditions and be happy with it.

Not only does the understaffing affect the nurse, it affects the patients. Most nurse have a personal reason for becoming a nurse; they have a deep desire to care for people, and may have had family members who were sick, and another nurse inspired them to go into the field. When a nurse compromises patients care, it becomes much more unbearable to work understaffed, knowing we could be causing harm to another human.

Another factor that influences employee’s motivation is the organizational culture under which they work. A strong culture will turn into a strong company. An organization culture “consists of shared beliefs and values established by leaders and then communicated and reinforced through various methods, ultimately shaping employee perceptions, behaviors and understanding” (Shrm, 2019). A hospital that is focused on keeping a good culture will make it a priority to instill their cultural identities to employees and new and prospective hires (Shrm, 2019). Not doing these things will lead to high turnover, disengaged employees, and poor patient outcomes. Even though a healthcare facility may strive to have a strong culture, when they are understaffed it leads to disgruntled, fatigued nurses, and the strong culture the hospital has worked to keep cannot be kept up with. When nurses are short staffed and frustrated, patients notice this, and their perception of their environment and facility changes.

In a study about nurse’s job dissatisfaction, burnout, and their frustration with health benefits leading to problems for patients, McHugh, Kutney-Lee, Cimiotti, Sloane, and Aiken (2011) note that there was a statistically significant effect on patient satisfaction ratings related to nurse burnout and nurse job satisfaction. The Study Showed that “the percentage of patients who would definitely recommend the hospital to friends or family decreased by about 2 percent for every 10 percent of nurses at the hospital reporting dissatisfaction with their job” McHugh et al. (2011). Most hospitals have a patient satisfaction survey they give to the patient at the end of their stay, and they rely on these results to see what the hospital is doing right, and what they need to improve on.

Literature Review

A review of literature follows in regards to: nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits causing problems for patient care, incivility causing burn out for new nurses, burnout in the workforce in healthcare, and the impact of nurse scheduling management on nurses’ job satisfaction.

Nurses Job Dissatisfaction Causing Problems for Patient Care

Staffing is not the only issue that affects patient care and outcomes. Nurses have several reasons to be frustrated in the field. Being short staffed, unsupported by management, and having poor work and life balance, are all causes of some of the major things that steer nurses from the field. When you work day in and day out under the same trying conditions, your attitude and work ethic suffer. Nurses become weighed down with the burden of all the units struggles, and it shows in every aspect or your day to day routine. Being in an inpatient facility providing direct patient care directly contributes to patient burnout. In a study done with over ninety five thousand nurses, “34 percent of hospital nurses and 37 percent of nursing home nurses reported feeling burned out in their current jobs, compared to 22 percent of nurses working in other settings” (Mchugh, et al.). The study showed that nurses in direct patient care, ie. Hospitals and nursing homes, had the highest rates of job dissatisfaction and burnout. Nurses were also unhappy with health and retirement benefits. 41 percent of the nurses who were surveyed that worked in a hospital and 51 percent of nurses who worked in a nursing home reported dissatisfaction with their benefits. When faced with these frustrations daily, on top of dealing with home life and other issues, these issues lead to distraction that takes away from patient care, leading to poor patient outcomes.

Incivility Causing Burnout for New Nurses

Most nurses can remember how excited they were when they finally graduated nursing school. They were so excited and hopeful to go out and change the world, so eager to help others. Soon after becoming a nurse you realize not everyone out there appreciates all the hard work you are putting in, and what you are sacrificing to be at work. With young and new nurses, there is a lot of hope that you will save everyone, form a lasting bond, and they will be the most grateful patients. This dream is quickly slashed. From the beginning nurses experience incivility from patients by being yelled at about pain medications, why hasn’t the doctor seen them today, why you weren’t in the room sooner, why is there food cold, or why can’t they go off the floor to smoke. You quickly see that all manner of people will be your patients, even those you would not choose to normally be around. Unfortunately since you are at work, you have to take whatever patients are on the floor at the time. This means if they verbally abuse a nurse, or threaten to hit, nurses are still obligated to take care of this person, and do it all with a smile. This is a shock to most people. Most other professions would not force their employees to put up with so much tolerated hostility towards their worker that was trying to do something good for someone else. How people feel they are being treated will greatly affect how they work for a company. We see so many nurses leaving the field in order to find something that doesn’t cause so much emotional distress. In a study done in China in 2016 of 696 nurses with less than 3 years’ experience, it showed that “Experience of workplace incivility by new nurses would likely generate anxiety in the victims. Further, the increased anxiety state could elevate their level of job burn-out” (Shi, et al.). We often worry about the mental health of our patients. We know that everything they are going through increases stress levels that can have a negative effect to their health. But is their enough focus on the mental health of nurses and health care workers? Although a person may not be physically sick, stress levels in a person can cause high levels of anxiety and depression and it affects many aspects of their life, including not being able to work at full capacity. There are many stressors to daily living. New nurses are juggling the beginning of their career, most with large student loan debts. They may have a family, or struggle to balance work life with the change in social life. They have just went through a lot of changes, they are now identifying as a nurse and not as a student. Starting off their career working in a place that tolerates incivility towards nurses leaves a nurse feeling unappreciated and they do not feel a sense of pride of belonging towards that place. So we must ask, are hospitals and health care facilities providing appropriate outlets for nurses? Support groups? Counseling services? These things are necessary not only to those feeling that incivility is a huge part of their work life, but also those who are having a hard time balancing all the life changes that happen when you become a new nurse.

Burnout in the Workforce in Healthcare

Burnout is not just seen in the nursing staff. The field is seeing NCT’s (or CNA’s) leaving, nurse practitioners, people working in blood banks and lab leaving. All across the field people are leaving for a number of reasons. The hours are long, there is not a set schedule, holidays and weekends must be worked, often time leaving those feeling like they missed out on a lot of things with family and friends. Not feeling appreciated or, like previously discussed, dealing with difficult patient’s day in and day out, and not a making a difference.In an article about published by the World Health Organization on “Health Workforce Burnout” Eaton tell us that “people experiencing burn-out typically feel exhaustion, but are also likely to feel detached or cynical about their job. They often perform less well at work, putting their patients at risk.” The article talks about one doctor who works in the emergency department at a place that is high is gang violence and sees many trauma causes. The work load was not the problem for the doctor, it was the chaos which he worked under. He talked about how many cases that came in that should have been cared for by a primary care provider, and this caused extra work load on a unit that was already understaff, and they could not deal with all of the trauma cases they saw on top of all the other patients. The article also lists excessive work-load and increasing patient expectations as contributors to burnout. Service needs are being increased in fields such as mental health, heart disease and cancer. The population in America is aging, and with that comes increasing healthcare needs. Although the healthcare needs of the aging population must be met, “The disparity between capacity and demand has led to an overburdened workforce, increased waiting times and a lower quality of service than patients expect” Eaton, 2019. This abundance of work and working with less staff contribute to the burnout in the nursing field we see today.

The Impact of Nurse Scheduling Management on Nurses’ Job Satisfaction

A person’s schedule is a huge impact on why they take and keep a job. A person would not take a night shift job when they had been on days for 10 years, and vice versa. A lot of people have a preference when it comes to their schedule. You may hear people say “oh I am just a night shift person! Always have been and always will be!”. Or a lot of people prefer the 9-5 schedule, off in the evenings with their families. Either way, people want options, and they want to be able to choose what is best for them and their family. Nursing schedules in hospitals do not allow for preference picking most of the time. Managers have to fill holes where they are needed, and workers don’t often get the schedule that is best for them or their family. This is another major reason people leave the field. Working holidays, often time the majority of holidays due to short staffing, leads to bitterness from missing so much time with family. Working 12hr shifts often causes healthcare workers to miss ball games with children, afterschool activities, getting children ready for school, family dinners, and outings with friends, etc. When people do not feel like they are getting a good home and work life balance, they want to fix that. Nurses want to be able to have the career we went to school for, imagined would bring so much joy from helping people, and be able to enjoy friends and family too. The harsh reality is that nursing does not often provide this. Yes, there are doctor’s office jobs, or discharge planning, or nurse navigator roles in which you have the 8-4 jobs. But being a nurse in the hospital is 12hrs of patient care that has to be done, no matter staffing ratios. Holes have to be filled, and the hospital never shuts down. This does not allow for people to have the schedules they pick out every time, and after so long on the floor, going through the same thing, they realize that other jobs that offer the 8-4 or 9-5 schedule better suits their lifestyle, and they are ready to leave for something that will give them better home and work life balance.

Part 3

In order to decrease nurse dissatisfaction, hospitals and other inpatient care facilities need to look at multiple things in order to grasp the reason for such high turnover. As previously discussed, nurse turnover is a costly expenditure. Many things lead to burnout and nurses leaving the field. Understaffing is one of the biggest causes of burnout and turnover. Nurses feel unsafe with the heavy work load of having extra patients. When mistakes are made from being short staffed, the nurses are the first to be blamed. Whether it be not answering call lights or bed alarms, it done not matter if there are less nurses on the floor and harder patients to take care of, it is ultimately the nurses fault when something goes wrong. There is also the frustrated that comes from non-competitive pay and health benefits. Nursing is a hard field to work in. When you work under stressful conditions, you want to be compensated for it. There are many jobs out there, and as nurses get older, really as anyone gets along in their job, you want the best retirement and health benefits to support you through years to come. Hospitals have to offer competitive pay in order to keep their nurses. Short staffing is an issue all throughout the nursing field. So if you can go to another facility, that offers more pay and better benefits, with the same field you have been working in, whether it is oncology or tele, why would you not go? The nursing field is still majority staffed by women. Although the age demographic in nursing is changing, most nurses start out in their 20’s. As young nurses become more experienced and gain years, they start their home life, and realize their health benefits are more important to them as children and spouses come along, and these things drive their decisions within their careers. Places that offer these benefits are more desirable to nurses and can bring them in to leave their jobs. So, to decrease dissatisfaction within the workplace, hospitals and inpatient care facilities need to look at their staffing ratios, and see if their health and retirement benefits are competitive with other inpatient units.

Incivility towards nurses in the workplace also contributes towards burnout. Incivility can be described as rude, inappropriate, or offensive behavior. As a new nurse this is not something you are warned of or expect at your new job. People do not have to work in places that cause them anxiety before, during, and after work. The nursing field covers many areas; there are thousands of jobs within each state that allow nurses to work at home, go to peoples home to assist with end of life care. Hospitals have to take into consideration that when nurses feel anxiety from incivility caused by patientcare, which is a huge part of their job, they will start looking for other places of employment that they feel does not allow for those situations, and feelings, to happen.

Working under stressful conditions like understaffing and increased patient workload can have a major effect on healthcare worker’s burnout rates. When staff work day in and day out with less help, and an increasing workload, quality of care also suffers. A work environment that is dedicated to compassion and caring cannot be maintained, and patient safety can be at risk. Dissatisfied patients will start taking out the frustrations on healthcare workers, this also leads to frustration on the nurse’s side, who often feel that their hands are tied in situations they have no control over, like short staffing. Turnover is a costly problem for a hospital to have. It can take a few months to hire a nurse, and get them completely trained. During this time, staffing is still low, and the problems with understaffing do not go away. So what does a facility need to do to have better retention rates? Nurses and healthcare workers want to feel appreciated. They want to feel that they are supported where they work, and that their employer/manager has their back in situations. One way a lot of Magnet hospitals, and larger hospitals are taking this into consideration is by creating a nurse residency program. New nurses take part of this for one year after the graduate alongside other new nurses. There they are able to discuss problems they face in their new careers, and get advice and support. Hospitals that do this see a significant increase in the retention of new nurses. Although there are many reasons for burnout, the shortage we see in the healthcare field today is being noticed in health care systems across the globe, and not just in the US. This pattern is being noticed by global healthcare organizations and is being investigated to try and find reasons for burnout, and how they can be reversed.

References

(2019, July 26). One in Five Nurses Leave First Job Within a Year. Retrieved from https://www.rwjf.org/en/library/articles-and-news/2014/09/nearly-one-in-five-new-nurses-leave-first-job-within-a-year–acc.html

Haddad, L. M., & Toney-Butler, T. J. (2019, January 19). Nursing Shortage. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK493175/

(2019, April 1). News & Information. Retrieved from https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage

“Where Did All the Nurses Go?” • Nursing, History, and Health Care • Penn Nursing, https://www.nursing.upenn.edu/nhhc/workforce-issues/where-did-all-the-nurses-go/.

Asegid, A., Belachew, T., & Yimam, E. (2014). Factors Influencing Job Satisfaction and Anticipated Turnover among Nurses in Sidama Zone Public Health Facilities, South Ethiopia. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953615/

Shrm. (2019, January 27). Understanding and Developing Organizational Culture. Retrieved from https://www.shrm.org/resourcesandtools/tools-and-samples/toolkits/pages/understandinganddevelopingorganizationalculture.aspx

Mchugh, M., Kutney-Lee, A., Cimiotti, J., Sloane, D., & Aiken, L. (2011). Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Affairs (Project Hope), 30(2), 202-21

Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., Dong, X., Sun, T., and Fan, L. “Impact of Workplace Incivility against New Nurses on Job Burn-out: A Cross-sectional Study in China.” BMJ Open 8, no. 4 (2018): E020461.

Eaton, L. (2019). Health workforce burn-out. World Health Organization.Bulletin of the World Health Organization, 97(9), 585-586. doi:http://dx.doi.org.ezproxy.uky.edu/10.2471/BLT.19.0…

this is the second one mark same criteria

The purpose of this paper is to explain how we arrived at the current state of high nursing turnover and burnout, evaluate the impact, and consider solutions.The three main reasons for the current state of high nursing turnover are an increasing aging population, insufficient number of nursing school graduates, and increasing nurse retirements.“By 2030, all baby boomers will be aged 70 or older, and the number of U.S. seniors will be 55% greater than that in 2015 (Buerhaus et al., 2017, p.40).As people age, they are more likely to require medical treatment which results in the need for more nurses.“Not only will demand for nurses increase, but also the intensity and types of nursing care required will rise” (Buerhaus et al., 2017, p.41).

The aging population of Baby Boomers is affecting the demand side of the equation but there are factors affecting the supply side as well.Nurses must complete a program of study accredited by the American Association of Colleges of Nursing (AACN).Then they must pass the National Council Licensure Examination (NCLEX).“According the (AACN), 64,067 qualified nursing applicants were denied admission to baccalaureate and graduate nursing programs” (Blouin & Podjasek, 2019, p.223). As difficult as it is to get into nursing school it is also difficult to fill faculty vacancies.“In a 2016-2017 survey conducted by the AACN, 56.2% of AACN member schools had open full-time faculty vacancies (Blouin & Podjasek, 2019, p.223).

The other issue affecting the supply side is increasing nurse retirements.The Baby Boomer population is also partly employed as nurses, so as they get older these nurses get closer to retirement.“The number of boomer RNs peaked at 1.26 million in 2008 (Buerhaus et al., 2017, p.42).Consider the knowledge and experience these nurses have and take with them when they retire.The retirement of approximately 1 million RNs is expected between now and 2030 and they will take this experience with them (Buerhaus et al., 2017, p.42).

Given the challenges facing the nursing workforce it is imperative to protect the supply of new nurses from burnout and subsequent turnover.RN burnout is a state of emotional exhaustion where a person is overwhelmed to the point of fatigue and has difficulty completing their tasks (Bakhamis, Paul, Smith, Coustasse, 2019, p.3).New nurse graduates are particularly vulnerable to burnout and turnover.Mounting demands within an increasingly acute practice environment have led to continued difficulties in new graduate nurse transition (Dwyer et al., 2018, p.37).Hiring and training new nurses is expensive.Estimates range from $82K to $88K per nurse (Dwyer et al., 2018, p.38).Nurse turnover can also affect patient care as new nurses are less experienced and capable of providing safe, effective care.Fluctuations in staffing due to nurse turnover can result in a high patient-to-nurse ratio.Patients are 7% more likely to die during hospitalization when a nurses’ workload is increased by even one patient (Dwyer et al., 2018, p.38).

To provide solutions, we must first understand that nurse burnout and turnover is a multi-faceted problem.It will require efforts across multiple fronts such as organizationally, intrapersonally, and interpersonally to have an impact.Organizational influences on nurse turnover can be defined as the organizational structures that facilitate access to information, support, resources, and opportunities to learn and grow (Dwyer et al., 2018, p.38).Organizations can tackle this area with clearly communicated and accessible policies and procedures.The hospital I work for has an intran

 

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