Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.
For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?
In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.
Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.
Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.
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The main discussion will need at least 3 references and also in APA 7 format
The two discussions below will need at least three references all in APA 7 format each
Competing needs in the world of healthcare exist on a number of levels including the national level and also at the most local levels. I normally work on a COVID free orthopedic unit that focuses mostly on diabetic amputations, elective joint replacements and surgeries following orthopedic trauma. Initially during the pandemic, we halted our elective surgeries which was consistent with national guidelines (Diaz et al., 2020). As numbers stabilized, we began elective surgeries again, but recently we have seen numbers of COVID cases increase locally. In the past few weeks, we have started taking on more medical/surgical patients in order to make room for COVID patients on other medical surgical floors. The competing needs in this situation include the needs of the hospital in terms of freeing up beds for COVID patients, staffing needs on my unit as we are taking on more patients, and also resources that we need in order to care for this new group of patients. The competing needs of the hospital in this case with regard to caring for COVID patients and also caring for other medical surgical patients resulted in a policy change on my unit. The policy change in this case was our switch from a unit that cared for orthopedic patients only to one that was more inclusive of other medical/surgical patients.
The stressor that I selected for the previous discussion was care of the elderly. One area of conflict that I constantly see is the desire of family members to provide care for patients in the home when they are unable to fully meet the needs of the patient. Some patients require 24 hour care and unfortunately many families are not able to fully provide that care. Caring for the frail elderly in the home is often preferred. However, informal care providers are often presented with the challenges of self-care, educating themselves about how to provide care, finding additional support, and a lack of societal recognition for the role that they play in healthcare (Plöthner et al., 2019). Despite the best efforts of family members and assistance from home care services, the level of care is still lacking, which places the patient at risk for declining health status. The competing need in this instance is the medical needs of the patient, competing with the ability of the family to provide those services or at least set up home care. A review by Hirschman and Hodgson (2018) identified several evidence-based approaches that may help to delay transition of care to skilled nursing facilities among patients with dementia. Programs such as the New York University Care Giver Intervention, Goals of Care intervention, MIND at home and Partners in Dementia Care help families to obtain the skills and resources required to provide adequate care to the dementia population in the home setting. The overarching theme is that while competing needs do exist in this area, education can help to reduce the burden on families and possibly help them to achieve the goal of home care for their loved ones.
Fortunately, policies are in place that prevent elderly patients from living at home when they are unable to receive adequate care. Recently I worked with at patient that suffered from severe dementia and his wife and children were working very hard to get approval to have him stay at home as opposed to being discharged to a skilled nursing facility. The patient is still on our unit, but it is questionable how the scenario will play out. At this point, a hearing is pending to determine if the patient requires a conservator. In the state of Connecticut, a conservator of the person is assigned to individuals determined to be unable to competently care for themselves. The conservator of the person is responsible for all matters including those related to finances and healthcare (“Conservatorships,” n.d.). Policy in this case will overrule the desires of the family to keep the patient at home and ultimately, the patient will be placed in the appropriate care environment.
Conservatorships. (n.d.). Retrieved from https://www.ctprobate.gov/Pages/Conservatorships.aspx.
Diaz, A., Sarac, B. A., Schoenbrunner, A. R., Janis, J. E., & Pawlik, T. M. (2020). Elective surgery in the time of COVID-19. The American Journal of Surgery, 220(2), 300-302. Retrieved from https://www.americanjournalofsurgery.com/article/S0002-9610(20)30218-X/pdf.
Hirschman, K. B., & Hodgson, N. A. (2018). Evidence-based interventions for transitions in care for individuals living with dementia. The Gerontologist, 58(suppl_1), S129-S140. https://doi.org/10.1093/geront/gnx152.
Plöthner, M., Schmidt, K., De Jong, L., Zeidler, J., & Damm, K. (2019). Needs and preferences of informal caregivers regarding outpatient care for the elderly: A systematic literature review. BMC geriatrics, 19(1), 82. https://doi.org/10.1186/s12877-019-1068-4.
Organizational Policies and Practices to Support Healthcare Issues
Competing needs can have a significant impact on the development of policy. This is mainly because the policy’s primary objective is to align with the needs (Tinetti et al. 2019). Therefore, in cases where there are competing needs, such as the needs of the patients, workforce, and resources, policy development can be challenging. For example, a policy to ensure the efficiency of service needs to consider the issue of nurses’ workload, stress, and burnout. Therefore, the policy would be required to address burnout, anxiety, and workload before proposing efficient health care strategies.
Specific Competing Need
Quality is a specific competing need in health care that affects nurse burnout. In health care organizations, nurses are expected to provide high-quality service that ensures the client’s safety and satisfaction (Saban et al. 2019). However, the issue of nurse burnouts in different health organizations affects this need. Thus, despite being expected to deliver high-quality services, the nurses could be limited to various problems such as stress and lack of motivation due to burnout.
The significant impacts of the competing needs include medical errors, nurse turnover, depletion of organization resources, and patient dissatisfaction. A high nurse turnover would require the organization to invest in new hires, which often require comprehensive training before adapting to the organization’s culture. Due to the stress and exhaustion associated with burnouts, the nurses will deliver lo quality services, which can result in increased errors and patient dissatisfaction.
How Policy Address the Issue
A policy can address these issues by ensuring that the nurses and the patient’s needs are addressed. In most cases, the nurses’ needs are a prerequisite to meeting patients’ needs. Nurses satisfied with their work will often be motivated, thus delivering high-quality work as observed by De Simone et al. (2018). In this case, the policy should address the nurse’s issues, such as reduced workload and shift hours to reduce burnout cases. This will, in turn, reduce the turnover rates as well as improve patient satisfaction rates.
De Simone, S., Planta, A., & Cicotto, G. (2018). The role of job satisfaction, work engagement, self-efficacy and agentic capacities on nurses’ turnover intention and patient satisfaction. Applied Nursing Research, 39, 130-140.
Saban, M., Dagan, E., & Drach-Zahavy, A. (2019). The relationship between mindfulness, triage accuracy, and patient satisfaction in the emergency department: A moderation-mediation model. Journal of Emergency Nursing, 45(6), 644-660.
Tinetti, M. E., Naik, A. D., Dindo, L., Costello, D. M., Esterson, J., Geda, M., … & Kang, G. (2019). Association of patient priorities–aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Internal Medicine, 179(12), 1688-1697.