Correlation of Nursing Staff Overwork and Patient Safety: A Hypothesis - Essay Sample

Introduction

There is a general shortage of registered nurses and that has led to hospitals using overtime and extended work shifts to cope with the shortage of registered nurses (Rogers et al. p.202). As the existing pool of registered nurses continue to be overworked, there is a need to evaluate if there is a correlation with the standard of patient safety in a hospital. This essay will be testing the hypothesis that there is an inherent risk of nursing staff making serious errors when their work shifts are longer than 12 hours, or alternatively, over forty hours each week.

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Integrated Nursing

The Institute of Medicine (IOM) published a report that presented 4 justifications for the use of integrated nursing (Dossey, p.4).These four dictums are:

Nurses must put into practice all of their nursing their education and training.

Nurses must continuously update their skills by going through all the cycles of nursing education in their field of specialty (e.g. pediatric, critical care, surgical nurses etc.).

Nurses must fully participates with other medical care professionals in designing healthcare systems.

The collection of empirical data must be the basis of creating an effective plan to use nurses as an effective workforce (Dossey, pp.4-5).

The import from these IOM principles is that nurses should be positive agents of change in healthcare systems. Hence they should structure nursing practice on a patient's health span rather than their life span (Dossey, p.5). The concept of integral nursing is ascribed to a comprehensive worldview on clinical care. This essay shall be arguing that integral perspectives on nursing opens the door for a holistic appreciation of the links between a patient's body, spirit, and mind.

Before touching on holistic nursing as a conceptual framework, there are a few more things that should be canvas in relation to what integral nursing practice is. It is the product of the efforts of Florence Nightingale (1820-1910). She is widely viewed as the person who created modern secular nursing by being the first person to ever devise a conceptual framework for nursing (Dossey, pp.8-9). She is the founder of the Integralist school in nursing theory. An Integralist nursing system focuses on the needs of patients by concerning itself with human and nonhuman concerns in clinical care (Beck, & Dossey. pp 258-263). Hence, an Integralist looks to the individual needs of a patient as well as how their immediate environment impacts their healthcare outcomes (e.g. access to clean water and clean surroundings).

The Integralist perspective on nursing care has become a core feature of nursing practice as a consequence of the changes in the profession ushered in by "Eras of Medicine" in America and Western Europe (Dossey, p.9). The first era was in the late 19th century as the field of medicine became more scientific. Hence, illness and health were seen as empirical things that can be tested. The healthcare on offer was exclusively focused on the creation of drugs to treat different ailments. During this time, a person's mental health was not considered as a source of a disease nor was it important to healthcare outcomes. Medicine was very paternalistic.

In the 20th century, bio-ethics moved away from this paternalistic model (Dossey, p.9). Therapeutic medical care emerged with the acceptance that a patient's mental well-being is an important factor determining healthcare outcomes. In the second era of medicine, human consciousness is thus limited to the patient and their interactions with their immediate environment and their present state of mind (Betancourt, "Ushering in the new era of health equity"). Today, medicine is in its third era when human consciousness is not localized. The consciousness of a patient is infinite and it can exist beyond the corporeal body (Dossey, p.9). Therapeutic care in the current era has absorbed practices from within and outside the field of medicine that help a patient connect to their consciousness to secure better health outcomes.

The current era of medicine has become the basis of structuring modern nursing practice under the Integrationist perspective of nursing care advocated for by Nightingale (Dossey,p.10). Today, nurses are essential in creating an internally healing environment in which they are a source of care, compassion, love, trust, and selfless service (Dossey, p.12). Integrated nursing also creates an internal healing environment by being driven by theoretical frameworks that, among other things, secures the union of a patient's body, mind, and spirit. Integrated nursing is therefore the basis for the theory of holistic nursing driving current trends in the field (Dossey, p.13).

Holistic Nursing

Holistic nursing links rational with paradoxical healing using "being" and "doing" therapies (Dossey, p.13). While "doing" therapies in holistic nursing relies on available therapeutic tools in contemporary medicine (e.g. prescription drugs, dietary changes, radiation, and acupuncture), being therapies do not (Kinchen, pp.238-246.). The later seeks to secure therapeutic healing by manipulating a patient's states of consciousness. The rationale for doing so is that human psyche has power to affect the health of a person in a positive or negative way. The manipulation happens through the use of non-conventional tools such as prayer to compliment the presence and intention of a nurse.

The import from the way holistic nursing is described in existing literature is that it has the basic assumption that inter-personal relationships between people is the foundation of effective therapeutic medicine (Dossey,p.16). Working from this premise, Pew Health Professionals (PHP) published a report in 1994 to give guidance on how holistic nursing can be applied within an integrated nursing system (Stalter & Mota, pp. 32-39). The report directed that this union must be dictated by three relationships namely: (1) patient-practitioner; (2) community-practitioner; and practitioner-practitioner relations. Since the thesis statement of this paper limited it to an evaluation of patient-practitioner and inter-practitioner relations on healthcare outcomes.

There can be no integrated nursing without the patient-practitioner relationship since today, therapeutic care is no longer paternalistic (Dossey,p.16). There is an expectation that in the patient-practitioner dyad, the later has an obligation to inter alia , engage in active collaboration with the sick or their next of kin to secure their informed consent on most courses of treatment(Khan, et al. 363). Hence a successful dyad between patients with medical staff has effective channels communication to preserve the dignity of the patient and the family as a safeguard against paternalistic treatment decisions.

The quality of patient-practitioner relationship relies on the quality of inter-practitioner relations. A practitioner-practitioner relationship needs each practitioner to appreciate the diversity of skilled knowledge in each of their co-workers so that everyone is working as a team to deliver good healthcare outcomes (Wei, et al. pp 1-8.). This collaborative nature of relationships between practitioners demands that there is constant communication and planning aimed at achieving common goals because there is shared responsibility for medical outcomes.

Holistic healing has various moving parts. Consequently, patient safety is essential to creating holistic healing environments (Dossey, p.822). A hospital will be deemed to have good standards of patient if it has an operational culture that minimizes risk of harm to patients through the constant evaluation of system effectiveness and individual performance. The biggest threat to patient safety is a breakdown of communication in the patient-practitioner and practitioner-practitioner relationships (Dayton & Henriksen, pp.37-47).

Patient Safety & Nurses Working Hours: The Linkages

A study has been done to see if there are linkages between working hours, nursing mistakes, and the loss of patient safety (Rogers et al. pp.202-212). In that study, most of the participants were female Registered Nurses (RNs). Furthermore, the majority of them were experienced staff nurses who reported more than ten years' working experience (p.203). All of them were classified as full time RNs because they had a work week of over thirty-six hours. Most of the participating RNs were based in facilities with more than 100 beds. The minority were employed in small towns and rural America.

The researchers used spiral-bound logbooks as the qualitative tool to collect primary data on hours worked, the times of day individual nurses were working, the days they worked overtime, days off, and quality of sleep (p.204). Subjects were required to fill out 17 to 40 questions daily in a questionnaire. These questions were about errors and close calls that may have happened during their work shift (p.204). Questions about quality of sleep nurses were asked during their off days.

The research findings were that staff nurses are over-worked each day (p.205). Although most participants weren't scheduled to work more than 12.5 hours, 14 percent of the respondents worked 16 or more consecutive hours at least once during period they were participating in the study. Collectively, the participants averaged 55 minutes longer than scheduled daily, and they worked beyond scheduled overtime at least once during the 4 weeks of the study. There were where participating nurses reported that the lack of enough staff nurses was used by their employer as the justification for imposing mandatory overtime and sometimes, they were coerced into voluntary overtime even after satisfying mandatory work shift requirements (p.206).

During the course of the study, the primary data collected from self-reporting showed that most of the errors and near errors concerned making mistakes when administering medicine (p.207). The minority errors involved charting, transcription and procedural errors. 30% of the participants reported at least one error, while 32 % reported one near error each day. The researchers concluded that the likelihood of a nurse making an error increases when they are subjected to working continuously for over 12 hours. These findings vindicate this paper's hypothesis that longer work hours for staff nurses endangers patient safety and compromises the holistic healing environment modern integrated nursing systems want.

The long and unpredictable hours documented here suggest a link between poor working conditions and threats to patient safety. The IOM report on medical errors directs that safer patient care is more likely when practitioners have a heathy work environment (Ulrich, et al. pp 67-84).So rather than blaming medical professionals, unless it is an instance of gross malpractice, reviewing the work environment for medical practitioners should be evaluated to protect patient safety.

Conclusions

The practice of integrated nursing, as advanced by Florence Nightingale, says that a good healing environment accounts for the needs of patients and creates the environment around them that secures good healthcare outcomes. It was only after the field of medicine underwent its three stages of development that integrated nursing became widely adopted as healing moved away from the position that the human psyche has no power in the healing process. IOM principles on integrated nurses says that they should be agents for positive change within healthcare systems. The concept of integral nursing relies on a comprehensive worldview on clinical care. Hence, it is the reason why the theory of holistic care is a dominant feature of modern nursing practice.

Holistic healing need functioning patient-practitioner and inter-practitioner relations. They are fun...