Research Korner: Nursing Profession

Exploring the role of the nurse in preventing and controlling risks factors in cardiovascular disease

Exploring the role of the nurse in preventing and controlling risks factors in cardiovascular disease Nurses are in a unique position to diagnose and treat human responses to actual or potential health problems. The nurse practitioner can have a positive impact on the prevention and management of cardiovascular disease through patient education and counseling.  Nurse Practitioners are oftentimes the first healthcare provider seen when there is a new patient.  The Nurse Practitioner conducts the initial evaluation and sets up the care plan which includes primary and secondary prevention strategies. The success of your patient teaching plan is measured through the patient’s compliance to the prescribed treatment plan.  Your teaching should be set up with goals that will enhance compliance. You need to make the assessment with the patient and family to focus on maximum compliance. Each visit should incorporate a review of the goals that were set and examples of how the patient is meeting or not meeting those goals. When you are following up during your visit to assess the success, if the patient has not followed the plan ask for the patient’s help to identify what is preventing him from being successful and revise the plan based on revised goals (Solomon, 2000). If the patient has even had small successes it is important to congratulate them and focus on those positives as you reformulate goals.  Provide the patient with resources to help support his plan. Remember that there are many references out there in the internet. Some are not so accurate, that may have just the opposite effect you and the patient are trying to achieve. By providing the patient with a take home list of resources you can be sure the information is the right information for the patient [http://nursesaregreat.com/articles/rrfh.htm].  The ICSI Health Care Guideline was designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients, and is not intended either to replace a clinician’s judgment or to establish a protocol for all patients with a particular condition.  The guideline outlines the existing evidence for the effectiveness of strategies and programs designed to help adults successfully make essential changes to achieve healthier lifestyles (increased physical activity, improved nutrition, decreased tobacco use and exposure, decreased hazardous and harmful drinking/alcohol use). It also outlines how these programs might be integrated into preventive services in health care systems, which traditionally have focused on early detection of disease or treatment of risk factors rather than preventing the onset of risk factors. Nearly all individuals would derive measurable benefits from healthier lifestyles; even small improvements across a large portion of the population would have a greater impact than focusing on a small portion of the population that is at the upper end of the risk distribution. Therefore, the target population for this guideline includes all adults (age 18 and older) in the community, irrespective of their utilization of the health care system. Although this guideline focuses on adults, adolescents and children may benefit from many of the components or recommendations in this guideline [http://www.icsi.org/chronic_disease_risk_factors__primary_prevention_of__guideline__23506/chronic_disease_risk_factors__primary_prevention_of__guideline__23508.html]. Nurse practitioners should follow these guidelines to create a successful educational plan for their patients.  They should teach the following four lifestyle behaviors – 1.    adequate physical activity 2.    a diet that emphasizes fruits and vegetables 3.    abstinence from tobacco and avoidance of tobacco smoke 4.    avoidance of hazardous and harmful drinking These are associated with a decade or more of increased life expectancy. Individuals, who adopt this lifestyle, at any age, have significantly lower total mortality rates [http://www.icsi.org/chronic_disease_risk_factors__primary_prevention_of__guideline__23506/chronic_disease_risk_factors__primary_prevention_of__guideline__23508.html]. After you begin your teaching plan it is important for compliance and success to evaluate where you are. This allows you and the patient to reset goals and stay on target. It will ensure greater success (Patient Teaching, 2001). Evaluation of lifestyle changes should be part of each visit to help the patient stay on track. Follow-up visits are planned based on patient needs. For example if you have a patient with elevated blood pressure and you are using lifestyle modification as an initial treatment plan you may want an every two week follow-up. For many patients a more realistic follow up is monthly. Evaluation and revision of the teaching plan is part of every visit [http://nursesaregreat.com/articles/rrfh.htm].

Exploring the role of the nurse in preventing and controlling risks factors in cardiovascular disease

E xploring the role of the nurse in preventing and controlling risks factors in cardiovascular disease Nurses are in a unique positi...

Do you agree that nurses have less privileged position among health care professionals? Justify your arguments with illustrations.

Do you agree that nurses have less privileged position among health care professionals? Justify your arguments with illustrations.   Nurses are responsible for the majority of patient care and hence they perform some of the most important duties in the patient’s stay in the hospital from monitoring vital signs into administering needed medications. Nursing, whom King (1981) defined as a helping profession that assists individuals and groups in society to attain, maintain and restore health, is the central tenet of health promotion. Nurses as human beings interact with their supervisors as human beings and both are open systems that also interact with the environment (Meleis, 2007, p. 330). Basically, the goal of nursing is the “attainment, maintenance or restoration of health to allow clients to achieve maximum potential for daily living.” Naturally, the same goal goes with the clinical practitioners including the nurses. Interactions are fundamental in the clinical context; individuals are purposeful and goal-directed particularly for the nurses who have direct interface with the patients. Nonetheless, the individuals who are involved in interaction bring various perceptions to the exchange. Plausibly, there must be a basic understanding that perception occurs differently in the nurse and in the supervisors aside from the clients. As Boyd (2005) puts it, the theory is a systems model which derived its conceptual framework from three dynamic interacting systems: persona, interpersonal and social. Individual system embraces the concept of perception, self, growth and development, time and space. Perception is considered to be the most important within the personal system because of its influence on behavior (1981, p. 19). Individuals or group(s) reacting to one another made up the interpersonal systems, and comes in three: as a dyad, a triad or a larger group. Kozier et al (1995) relate that concepts associated with such system include interaction, transaction, communication, role and stress. Social systems, finally, comprise of groups of people in a community or society that share common goals, interests and values (Williams, 2001) and are linked with the concepts of organization, authority, power, status and decision-making. Supervisors hold a specific power of influence among the nurses. Such condition basically manifests the varying perception of supervisors and nurses. As a supervisor, they have more authority and influence to the health care system. As such, the relationship that exists between supervisors and nurses is multi-paradigmatic in nature. Two among these paradigms that support the power inserted by the supervisor over a professional yet mentoring relationship is evident on systems. The former is central on structural-functional view of role, open systems and social systems while the latter focuses on the self who is either the supervisor or the nurse. This also points out that an individual as a social element is both an actor and a reactor. Aside from the client’s personal information, the professional intimacy between a nurse and a patient is realized through the psychological and social elements associated with the encounter. In the outpatient clinical setting, it is unavoidable that a nurse will have to rely on his/her supervisor for professional counseling needs. This is yet another goal of the nurses which is to involve in a relationship without sacrificing the professionalism of the job. Realizing a lot about the nurse-patient relationship which is basically founded on specific boundaries and that crossing such boundary may impose serious consequences. The purpose of the relationship is goal-oriented; simply to provide care to client, that is. Of course, the emphasis is on the role of the nurses. The nurses are responsible for establishing and sustaining the professional relationship and so his/her behavior is guided by code of ethics and professional standards. These nurses also have the responsibility to prepare for the relationship via acquiring formal knowledge, orientation and training.    References Boyd, M. A. (2005). Psychiatric nursing: Contemporary Practice (3rd ed). Lippincott Williams & Wilkins. King, I. M. (1981). A theory for nursing: Systems, concepts, process. New York: John Wiley & Sons. Kozier, B., Erb, G., Blais, K. and Wilkinson, J. M. (1995). Fundamentals of nursing: concepts, process, and practice (5th ed). Redwood City, CA: Addison-Wesley. Meleis, A. F. (2007). Theoretical Nursing: Development and Progress. Lippincott Williams & Wilkins. Williams, L. A. (2001). Imogene King’s interacting systems theory – Application in emergency and rural nursing. Online journal of rural nursing and health care, 2(1).

Do you agree that nurses have less privileged position among health care professionals? Justify your arguments with illustrations.

Do you agree that nurses have less privileged position among health care professionals? Justify your arguments with illustrations. ...

Contemporary Issue in Professional Practice: How to combat the shortage of Registered Nurses?

Contemporary Issue in Professional Practice     How to combat the shortage of Registered Nurses?   Introduction The topic about combating the shortage of registered nurses is chosen to be the focus of essay discussion by the researcher due to the fact that she is amiably aware of the importance of nurses’ role as well as functions in health care, chosen to address possible needed factors in combating nursing shortage and keep command to effective nursing profession within the nursing care milieu, as these kind of shortage is present Shortage of registered nurses (RNs) assumes a contemporary issue into the nursing care practice as it poses real situation into health care setting hitting almost all related domains like, the hospital care team since, the shortage of nurses will be felt due to lack of proper management handling and other factors affecting the nurses’ workplace environment. Buchan (1999); Duffied and O’Brien-Pallas (2002) and O’Brien-Pallas et al. (2003) indicated a well documented to evidence of nursing shortage as  now happening  hitting almost being exacerbated by the aging nursing workforce in combination with an aging general population and increasing acuity of institutional clients (O’Brien-Pallas et al., 2003) The need to combat shortage of registered nurses is one ideal process to think, act and decide.  According to Zurn et al. (2005 p. 608), there can be certain ways to address concerns as core strategies to combat nursing shortage, as indicated below -          Increasing new recruits to the profession -          Retaining Registered Nurses (RNs) currently employed in nursing -          Attracting RNs who have left the profession back into nursing employment   Literature Zurn et al. (2005), noted that “such health human resource shortages have been described as symptomatic of inadequate recruitment and retention strategies” which are important in combating the shortage reality of the issue known as the shortage do occur into cyclical phenomenon (Buchan and Calman, 2005). However, “even if recruitment initiatives attract sufficient new nurses to the system, there is currently a shortage of nurse educators to assist them through the required nursing education programs”, (Buchan, 1999). Furthermore, Waldman et al., (2004) reported that some of the turnover costs does affect the growing shortage of nurses and how to better combat the situation several nurses are hired due to the demand of the nursing care profession  (Waldman et al., 2004). Thus, some RN demographics suggest that retirements will make up an increasingly larger component of turnover. Retirement turnover results in a greater loss of nursing capital i.e. the acquired knowledge, skills and abilities of retiring RNs. The loss of productivity, which occurs while new recruits move toward job competence and mastery, is an often unrecognized cost of staff replacement. Furthermore, Aiken et al. (2001) mentioned that, “each individual who enters the profession of nursing should be capable of adaptive behaviors with a goal of achieving optimal health. It is obvious that the nursing profession is in grave danger. Some of the students have no intention of practicing nursing but are using nursing schools to receive a degree to move on to other fields such as law and medicine. The fact speaks volumes about nursing schools, their student admission, the curriculum and faculty which are reason for the such nursing shortage”. The burden of nursing is another reason for the nursing shortage. Many people who are entering or have entered schools of nursing may be working on a second profession or forced into the profession because of loss of jobs in the past, looking for never-ending employment and perhaps nursing was a lifelong desired career but was unable to pursue it because of other obligations as nurses strike for more wages that are compatible with their education and work status and a more humane working conditions. (AACN, 2001) There are many issues that must be resolved before nursing crisis be avoided. It is important that all nurses continue to advance their knowledge base. It is important that nursing school administrators obtain qualified faculty members who are truly practice nurse-oriented. (Steefel, 2004) The retention rate in the schools of nursing would increase if schools of nursing included as a mission to help students know and believe in themselves, take advantage of resources and opportunities, set and achieve their goals, learn throughout their lives use the nursing profession to build fruitful and satisfying relationships with others. (Steefel, 2004; Healthcare Financial Management, 2002; Goodwin, 2002)      Combating the Shortage The initiative to get most federal workforce as addressing complaints about working conditions and concerns over quality of care, California took the lead on setting minimum nurse to patient ratios in 1999. (Kimball and O'Neil, 2002) The legislation established minimum staffing levels for registered nurses and licensed vocational nurses working in hospitals and also limited the tasks performed by unlicensed personnel. (Kimball and O'Neil, 2002) The joint commission developed staffing standards that do not mandate specific staffing levels or ratios, but instead require organizations to determine their own ratios based on factors such as nurse competency and level of patient needs. Oregon enacted legislation in 2001 that requires hospitals to develop nurse staffing plans. (Oregon Nursing Shortage, 2001) Nursing authorities have joined forces with health care providers, business and other stakeholders and these regional projects is now in over twenty states bring people together to implement permanent systems of nursing workforce planning. (Peterson, 2002) There are a lot of people out there with really good ideas and these collaborative efforts are on the right track of solving what is a "very local issue’’ and to fill gaps, hospitals have looked to temporary nurses and unlicensed personnel to cover their immediate needs. (AACN, 2002) Thus, nursing care institutions can possibly offer good nurses’ incentives like performance bonuses as well as higher salaries in addition to other things geared to improving nursing working conditions into recognition and health care programs to possibly not be in shortage situation thus, assuming better ways to improve the image of nursing care and practice notion. (AACN, 2002) The need for enough number of registered nurses to partake in health care services to serve rightly, some nurses are retiring or leaving the profession before retirement. (Sochalski, 2002), and few people are entering nursing because other professions are doing a better job of attracting a new generation of workers, men and women alike as there argues that the primary factor leading to this nursing shortage is declining interest in nursing among women, who now have many more career options than in the past. (Sochalski, 2002) The need to avoid workplace dissatisfaction in the nursing care (Aiken, 2001) and here some key findings of research that, only 34 percent of surveyed nurses reported enough RNs to provide high-quality care in the facility where they work, that 29 percent reported that nursing care agency should listen and respond to registered nurses' concerns to spare off any shortage, as nurses who are dissatisfied are the ones likely to experience pressure and too much issues in the workplace than seeing worthwhile compensations and salary systems. Thus, having nurse shortage applies to the usual solutions such as hiring bonuses and education reimbursement may help in the short run but won't solve the underlying issues. Fest (2004) asserted the “core retention issues will also address the key recruitment issues that keep candidates from entering the profession. Nurses need work environments with strong professional practice models that value their work and recognize their impact on patient outcomes”. There should be a crucial look at a health care system under stress and the declining quality of medical treatment in the country from registered nurse's point of view. It should serve as better wake up call for health care providers concerned about the quality of health care. (Steefel, 2004) One thing has not changed that is the dedication and care nurses provide to patients and nurses' continuing desire to make a difference in patients' lives. Now, when the mean age of inpatients is older, there are fewer resources at nurses' disposal to assist in the care of those patients. (Steefel, 2004; AACN, 2001) The problems associated with the nursing shortage and the quality of healthcare delivery to the customer in lieu to the issues perceived in the health care system today that must be address for providers interested in broadening their knowledge base about needed reformation of the health care system and how to take more proactive role in the reformation and is used to stimulate discussion in nurse leadership groups in health care facilities for the patients and customers. (CNN News, 2001) In addition, to combat the shortage of registered nurses, the following good points have to be realized and applied into the nursing care process and actual professional practice The consultation and communication – there will be the need for an expressed desire for improved consultation with nurses regarding changes to the health care system, combined with improved communication regarding such changes. There was a sense that, in their experience, only superficial dialogue had been undertaken, and that advice offered from front-line nurses was not incorporated into change plans. Recognition – RNs described a strong yearning to receive recognition for their efforts from those higher in the organization. While they felt appreciated by clients and their families for their work efforts, there was the perception of a corresponding lack of gratitude from their employer. Given their descriptions of heavier workloads and other indicators of a worsening work environment over the past decade, this lack of recognition was keenly felt. Adequate staffing levels – some participants reflected on the personal impact of this heavier workload at a time when they themselves are beginning to feel the affects of aging. There was strong sentiment that staffing levels would have to be improved in order to keep older nurses in the system: The changes would make people stay is to somehow give them the time to practice nursing the way they see they need to practice, to not just be so run off your feet that you cannot even think about what you've done. You need time to process; you need time to make a human connection. Supportive management – nurses spoke of the need for support from management. Because participants had worked as a nurse for at least a decade, they were able to compare the current situation to that prior to the health care restructuring as expressed ideal desire to return nursing effective structure which included front-line nurses as being empowered to make unit level adjustments as required to better meet the needs of patients needing care: Flexible work schedules – work-life balance was raised as an issue by many of the nurses who were trying to manage their home and professional lives. There was a common desire for work schedules that are more responsive to their need to balance these competing demands and to adjust to the physical changes of advancing maturity: More flexibility working hours for nurses, that's very important through better scheduling. and realize there's a lot of job to finish. Support for new nurses – these long-term nurses saw real need to pass on their acquired wisdom and knowledge to new nurses and expressed a willingness to assist new graduates adapt to their chosen profession as due to their current heavy workloads, there was inadequate time to provide the level of orientation and support that new nurses require. They sought a systematic solution to this problem and praised a new mentoring program being initiated in their health region: Professional development – Educational opportunities as being valued amongst the registered nurses as they lamented the lack of profession development available and suggested that more resources need to be directed toward continuing nursing education. Again with the issue known, length of working years have remain to drive in the professional development opportunities as available into nurses’ career formation thus, enabling nurses to find better means to be in command into the work environment.   Implications for Practice For implications in practice, good and bad side will be in explaining mode. For the good side of the shortage of RN is that, there will be much more positive change, options towards better nursing care set up, the need for much effective nursing care allowing nurses to keep track of their career avenue and performance recognition and assessment , there maybe reality that these registered nurses will imply and utilize several useful vibes towards great workmanship, efficient driven values formation and better services given upon actual care. Meanwhile, the bad side can be about the presence of such competing pressures of RNs work environment being felt that are gradually taking toll, by which if not being combated at the same time addressed constantly, will impose a quick negativism and outcome into such adverse impact on registered nurses shortage rates as compared with retention rates of the nurses. The underlying outcome might involve a crippling effect of such known ability of nursing care systems to provide good and innovative level of nursing research and care patterns as it would be essential that nursing shortage have to be in parallel with some of the pressing issues into the nursing care practices from within it would be wise for the health care policy makers to ideally listen to there vocation calling than any other factors affecting good stance of nursing services from with aspects of actual experience without too much expectations on rewards, incentives and other motivation materials at hand. Furthermore, definite case clears the issue as there can be dedication providing support for nurse leaders that make decisions related to patient care assignments, such as the North Carolina Organization for Nurse Leaders supports staffing patterns that promote safe patient care. The nursing profession has gradually accepted responsibility to assure that safe and accessible healthcare is available to the public even in times of nursing shortages. The profession continues to accept better responsibility and identifies strategies to promote the best possible patient care and do recognize in several healthcare institutions, the traditional skill mix involving registered nurses, licensed practical nurses and certified nurses assistants has evolved into teams of professionals, which include interdisciplinary approaches to care. Registered nurses are at the forefront of leading these teams and collaborating with the patient's plan of care In an effort to effectively manage patient care and the nursing shortage, healthcare settings expanded the role of the nursing assistant; however, the registered nurse has increased accountability for ensuring standards of patient care. With this expanded role of the nurse assistant, healthcare settings should make every effort to provide ongoing training and competency validation as per accreditation and regulatory standards. Although nursing shortage is not unlike previous shortages, concern arises when the average age of the bedside nurse is taken to account as well as the decreasing enrollments noted at colleges and universities of nursing students. In addition, we are seeing experienced nurses leave traditional acute care settings for less stressful yet more lucrative position outside of acute care. Combating strategies will be realized for one, means of increasing nursing school enrollment and promoting effective advancement of nursing practice will assist in the long-term retention of nurses. Nursing care background should be managed well and duly evaluated  into the nursing practice upon ensuring workplace provision for achieving quality health care for patients. As some of the hospitals do continue to place ample "human experience" into a more tangible nursing reality. The nurse shortage have to be avoided as much as possible that the registered nurses should emphasize active involvement into the nursing care as well as nursing issues that will trigger nurses’ performance to go down opening doors for the shortage.     Conclusion The combating of nursing shortage have had provided effective ways to fight the phenomenon and keep the number of registered nurses stable along with potential approach from having better stance into the nursing care research and profession thus, allowing registered nurses to maintain a strong goal and vision into the health care service without anything in mind as it can be within organization of ideas combating any shortage presence. Therefore, the need to motivate the nursing care units are one of better consideration keeping up nursing shortage less and that to combat the shortage of nurses, support for needs and professional development can place a vital factor avoiding shortage, the need to imply satisfaction and good domains of nursing practice to execute good working benefits and awards as placed within ample context and perspective of the registered nurses. There sharing of not just ideas but with ideal nurses’ attitudes and emotions for ethical process that can be behind several reasons why there is nursing shortage in today’s medical society. To combat shortage, proper nursing research planning and implementation of various approaches are required for application purposes, the need to understand several expenditure points as well as valuable resources from spontaneous ideas and profile of the nursing workforce  such as those developed in Malaysia and that, nursing retention policies should be attend to and be developed quickly before some of the registered nurses choose to lessen their work loads as premature as it is into the personal careers dominance.     Therefore, RNs do perform the most important duties during a patient’s stay at the hospital, from monitoring vital signs to administering necessary medications but during the past years, there was rampant shortage of nurses in healthcare industry and that this shortage is expected to increase in the years to come. Furthermore, as hospitals and clinics struggle to recruit nurses, some nurses are seeking other avenues of job or other options to work happily. The presence of creative staffing may not fill the void of nurses that remains, there are other ways in which people are working to salvage the nursing profession in a country. The most important way in which the nursing shortage can be addressed is through this avenue. In order for the shortage to begin to be alleviated, the lack of funding and space in these nursing programs needs to be evaluated because of constraining factors, not enough applicants can be accepted and nursing shortage continues to grow. Aside, in order to meet the rising demand for registered nurses, nursing care institution must be able to operate to their fullest capacity and the budget changes should reflect that. The other ways the shortage are to be addressed are by means of recruiting programs as there is responsible for rounding up qualified applicants for vacant positions into such demanding job options attracting more RNs and that, hospitals may continue to suffer from the shortage reality until some budgetary issues are resolved respectively.   References 1.    Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Busse, R., Clarke, H., Giobannetti, P., Hung, J., Rafferty, A.M., Shamian, J. (2001), "Nurses' reports on hospital care in five countries", Health Affairs, Vol. 20 No.3, pp.43-53. 2.    American Association of Colleges of Nursing. (2001). AACN's Nursing Shortage Fact Sheet, Washington, D.C American Association of Colleges of Nursing: AACN's 2001 Annual Report 3.    American Association of Colleges of Nursing. (2002). Enrollments Are Rising at U.S. Nursing Colleges and Universities, Ending a Six-Year Period of Decline, Washington, D.C. 4.    Buchan, J. (1999), "The ‘greying’ of the United Kingdom nursing workforce: implications for employment policy and practice", Journal of Advanced Nursing, Vol. 30 No.4, pp.818-26. 5.    Buchan, J., Calman, L. (2005), "Summary: the global shortage of registered nurses", The Global Nursing Review Initiative, available at: www.icn.ch/global/summary.pdf, . 6.    CNN News. (January 12, 2001).  Some worry nursing shortage could put patients at risk http://archives.cnn.com/2001/HEALTH/01/12/nursing.shortage/ 7.    Duffield, C., O'Brien-Pallas, L. (2002), "The nursing workforce in Canada and Australia: two sides of the same coin", Australian Health Review, Vol. 25 No.2, pp.136-44. 8.    Fest. G. (2004). Federal funds to ease shortage falling short Administrators forced to turn away most applicants who have applied to two popular nursing programs http://www.nurseweek.com/news/features/04-08/funds.asp 9.    Goodwin, K. (2002). States Tackle the Nursing Shortage: The Lack of Qualified Nurses Is Reaching Epidemic Proportions. States, Universities and Hospitals All Are Trying to Do Something about It Magazine Title: State Legislatures. Volume: 28. Issue: 9 National Conference of State Legislatures Gale Group 10. Healthcare Financial Management. (2002). Congress passes legislation to ease nursing shortage Updata - Nurse Reinvestment Act 11. Kimball, B. and O'Neil, E. (2002). Health Care Human Crisis: The American Nursing Shortage. The Robert Wood Johnson Foundation, Princeton, NJ 12. O'Brien-Pallas, L., Baumann, A., Villeneuve, M. (1994), "The quality of nursing worklife", in Hibberd, J., Kyle, M. (Eds),Nursing Management in Canada, W.B. Saunders, Toronto, pp.391-409. 13. O'Brien-Pallas, L., Alksnis, C., Wang, S., Birch, S., Tomblin Murphy, G., Roy, F.A., Sajan, P. (2003), "Early retirement among RNs: estimating the size of the problem in Canada", Longswoods Review, Vol. 1 No.4, pp.2-9. 14. Oregon Nursing Shortage. (2001). A Public Health Crisis in the Making. Issue Brief No. 1, Northwest Health Foundation 15. Peterson, C. (2002). In Short Supply around the World, the Need for Nurses Grows, Nevada RNformation 16. Sochalski, J. (2002). Nursing Shortage Redux: Turning the Corner on an Enduring Problem, Health Affair 17. Steefel. L. (2004). Bridges or Barriers Will new certification rules for foreign nurses protect patients or intensify staff shortages? http://www.nurseweek.com/news/features/04-07/visa.asp 18. Waldman, J.D., Kelly, F., Arora, S., Smith, H.L. (2004), "The shocking cost of turnover in health care", Health Care Management Review, Vol. 29 No.1, pp.2-7. 19. Zurn, P., Dolea, C., Stilwell, B. (2005), "Issue paper 4 – nurse retention and recruitment: developing a motivated workforce", The Global Nursing Review Initiative, available at: www.icn.ch/global/Issue4Retention.pdf, .

Contemporary Issue in Professional Practice: How to combat the shortage of Registered Nurses?

Contemporary Issue in Professional Practice How to combat the shortage of Registered Nurses? Introduction The topic abou...

CASE (PICTORIAL) ANALYSIS

CASE (PICTORIAL) ANALYSIS   Introduction   Health care contributes over 10 percent of gross domestic product of most developed nations. Nursing is one of the top occupations in health care in terms of job growth. Anywhere in the world, we see individuals taking up studies in nursing. Although majority of them we cannot gauge if they really have their heart in it, the fact still remains that many individuals take up nursing and would soon be taking care of ill patients in health care settings.   Health care is a major concern these days, considering that the population is growing. People are more aware of their health today than they are years ago. Advancements in technology play an important part in people’s awareness – people can now be easily diagnosed of their illnesses and technology can also help prevent further occurrence of some diseases. Because of these, people live longer than before. Everybody in the world has experienced health care in many ways, like when we go to the doctor for checkup or when we go to a health organization to be immunized. But most of the time, we see the nurses in the front line of providing us with the health care services that we need.   Effective nursing and health care concern has been and still is a growing concern for everybody. Many problems threaten the very foundation of the nursing profession. Among these are nursing shortages, wrong education of the nurses, and nurses whose hearts aren’t really in the profession but in the high pay which the profession brings in.   Different people have different perspectives about nurses and nursing care. A nurse could be different from one person to another. We all have different understanding of nursing. This paper will examine two photographs which depict areas in the nursing profession and will attempt to analyze the images, identify the issues, and think about the issues.   Context   Two photographs are provided for this paper. First, there is a need to describe these images in detail. Second, based on the photographs, nursing issues will be presented. And third, these issues will be discussed.   The first photograph is a black and white image of several nurses together with a man. The man looks like someone of authority, someone who is accustomed to giving out orders. On the other hand, he could be a priest. But then, we can only guess. The man is wearing an all-black suit in the photograph, but then again we cannot really be sure since this is not a colored photograph. At the back of the nurses is a large tent.   The nurse at the farthest left beside the man seems to be looking or reading at something which looks like a piece of paper in the man’s hand. Most of the other nurses took no notice of this but look straight into the camera. Some faces are just passive while some are also smiling.   This photograph could have been taken sometime before the 1950s and maybe during the war. These are like nurses assigned to take care of soldiers in battle field. Or they could simply be nurses on some health care mission to less privileged areas. They look like a bunch of children getting ready for a class pictorial.   The second photograph is a colored one and looks more recent that the first one. In this photograph, there are only three persons. On the front is a white man who, judging by his clothes, is a medical doctor. Behind him, on each side are two women. One woman is dark skinned while the other woman‘s ethnicity cannot be judged since she further back and the picture starts to blur. This picture seems to be taken within the hospital halls.   This photograph looks like more of a promotional picture for a television show featuring doctors and nurses within the hospital setting. You could see that they are posing like models with arms folded and feet apart and staring straight into the camera with serious determined faces, or at least I could tell by the doctor’s face.   Identification and Discussion of Issues   Going back to the first photograph with the nurses posing for the camera with a man clothed in black, let us identify the issues that can be gauged from the picture.   From the photograph, three issues can be presented: (1) nurses usually work with other nurses in the provision of health care services, (2) in the provision of these services, other individuals could be involved – even if these individuals are not health care professionals, and (3) if we compare this picture to pictures of group nurses or team nurses at present, we can conclude that this team in the picture comprises more nurses than most nursing teams at present. This only goes to show that perhaps there is a growing shortage of nurses at present.   Nurses can work alone. But nurses can also work in groups. Collaboration, they say, is the key to success. Nurses working together can provide a better quality of service, thus improving patient’s health also. In most cases, nurses work in groups or in teams where there is a leader assigned to take in charge and lead the group.               Other individuals are involved in the provision of health care services by the nurses. By this, we do not mean other health care professionals but ordinary citizens or even the patients themselves. People had a right and a duty to participate individually and collectively in the planning of their health care. This highlight the importance of nurses looking at their practice critically and maintaining up-to-date research-based knowledge, illustrating that healthcare professionals need to be empowered to empower others effectively.   We question – why is there a growing shortage of nurses when in fact we see more and more people taking up nursing profession in schools. The growing shortage of nurses is due to the fact that the world is growing. More nurses there may be, but still population is growing day by day.               A nursing shortage in almost all countries has been reported. There are a number of strategies made in dealing with the crisis. With the total population of the world growing, along with the different mutated new diseases that attack the bodies of man, the population growth was expected along with the nursing shortage.   In the second photograph, an issue to raise is that nurses work with other health care professionals in the provision of health care services. As depicted in the photograph, nurses work with doctors. Partnership between doctors and nurses is seen to be an essential prerequisite to the success of providing the best quality of care to the patient, and the key to successful partnership within health visiting practice is mutual respect and open communication between parties. There should be no feelings of jealousy, instead, health care professionals should collaborate and cooperate with each other.   Comparison and Differentiation   Comparing the two photographs only in terms of how it looks can generate many differences, not similarities. To name a few, these differences includes the number of nurses in the picture, the clothes of the nurses, and the color (or lack of it) of the photograph.   Nurses nowadays not only wear white during their duties. They wear other colors too in their duty, like the color blue. The style of their uniform also varies. In the old photograph, the nurses are wearing skirts – long skirts which made them look like they are wearing gowns; while in the newer photograph the two nurses are wearing pants.   In both photographs, we can see that nurses are not alone in their quest of providing quality health care services. In the first photograph, we see that the nurses are with a man who seems to be helping them in some sort of way. In the second photograph, the nurses are with the doctors who are undeniably able to help nurses and can also play a big impact on the role of the nurses.   In both photographs, we can safely say that nurses are being provided with support from different sides. Nurses get support and empowerment from fellow health care professionals like the doctors and also from other individuals, even their clients. Empowerment is defined as "moving decision making down to the lowest level where competent decisions can be made" (1998).   Representation and empowerment of clients raises important issues. If nurses are to truly follow their code of professional conduct, they must view nursing not as a source of power, but as a means of empowerment through the sharing of knowledge (1999).   Discussion   By working in partnership with doctors and even clients, nurses can best represent their needs and redistribute power for the good of all concerned. A critical appreciation of the sources of influence in health care is important. Yet, more importantly, unless nurses can learn to represent themselves, their interests and those of their clients more effectively, they will continue to be a large body of professionals with a relatively small voice within the wider political, social and health care arenas ( 1999).               The nurse has a dual role to play in providing a service for clients and helping clients to access appropriate services. The client’s right to health care confers on nurses an obligation to assist clients to meet their individual health needs. Representing the client can take two forms – advocacy and empowerment.   The nurse-client-relationship has for some decades been considered the cornerstone of nursing (1996). In nursing research and practice the nurse-client relationship is a central theme. The nursing care partnership model, challenges the traditional, professional helping- role characterized by objectivity and neutrality, both of which have dominated psychiatry. They reason that changing social conditions and new health problems require an alternative model of nursing practice.   Nursing care plans are a guide to nursing practice. These are either specific to nursing or integrated in multidisciplinary treatment plans. One purpose of nursing care plans is to ensure inter-professional communication. Nurses working together can learn from one another’s nursing care plans they make for their patients.   There is also a need for nursing organizations to empower their staff to deliver client-focused care. Empowerment should come not only from doctors or clients but also from the other nurses. These could who work together in the same health care setting or these could be nurses of an entirely different hospital setting.    In the hospital setting, this would most commonly be at the point of direct client care or staff nurse level; however, this kind of empowerment requires an environment of autonomy where mutual trust and respect are encouraged. The empowerment process requires that staff be prepared to accept and effectively use expanded decision-making responsibilities (1998).   To start changing the work environment into a healthy one, there should first be mutual trust and encouragement in all the parties involved. Each and every opinion should be respected and given consideration in the decision-making process. There should also be an all-out support for this desire for change.   Incorporated within the concept of empowerment is the individual's willingness to see the vision and make the personal changes necessary to connect with that vision. It is how the concept of shared leadership works (2002).   Developing an empowering culture in which positive relationships are nurtured, leadership capabilities are developed, and professional practice is supported can improve the work environment and satisfaction of staff nurses (2001). Simply put, collaborative work relationships should be actively enhanced and promoted in order to create a positive work environment.   The professional accountabilities of the empowered nurse includes having a sense of value about their work and willingness to provide the full scope of practice as well as ability to work as equal members of a comprehensive interdisciplinary team. In order to move into a fully empowered position, professional nurses need mentoring, education, awareness of political activism opportunities, and networking skills ( 1998).             On the other hand, individuals who help the nurses can also restrict practice and provide a form of control over nurses. It is plausible to infer from this that power is being exerted over nurses and by nurses in many situations. Thus representation has now become a key issue for the status and future of the nursing profession.   Conclusion   The role of nurses in the world varies, as we can see in the two photographs. They could be in the open field with other individuals who aren’t health care professionals or they could be in the hospital with the doctors and other health care professionals. But even though their roles vary, they serve only one purpose: to promote and practice health care thru the knowledge they earned from training and practice.   It is the job of the nurses to take care of those who require health care. It is their job to give quality health care so that patients will get cured and will have confidence in their safety and the excellent practice of medical practitioners. Both patients and doctors could benefit from the nurses.   A good nurse shall also serve as a model to her fellow nurses and nurses to be, and teaches them good ethics and practice. A nurse must also be adept to new technologies, especially those that pertain to medicine. Over the years, we can see as is in the photographs that nurses have changed yet there is one thing that didn’t change. And that is the continuing provision of the best quality of care to those who need it.

CASE (PICTORIAL) ANALYSIS

CASE (PICTORIAL) ANALYSIS Introduction Health care contributes over 10 percent of gross domestic product of most developed na...

Understanding the Shortage of Nurses in the Light of Economic Concepts

Understanding the Shortage of Nurses in the Light of Economic Concepts                                   Introduction               Nursing appears to be the growing buzzword profession in the early years of the 21st Century.  Individuals from the different parts of the globe are preparing themselves to join the nursing workforce, for different reasons.  However, we have to face the reality that the health care industry is having a shortage.  An understanding of the basic economic concepts helps in understanding the problem of nursing shortage.    Basic economic concepts vis-à-vis nursing and health care                         Capitalism is the existing economic structure for the most nations-states across the globe.  The accumulation of wealth is the name of the game, and that is through the accumulation of profit from the capital.  In other words, the more money an individual has the better.  One’s profession is the source of one’s wealth, or economic wealth so to speak.  In today’s era, one of the pools of money comes from the profession of nursing or health care.                Nurses pledge to serve; but from an economic perspective, they are making use of their labor, which serves as their capital.  At the back of their so-called service is a high economic premium.  In effect, other countries turn to have a high human capital because of the migrant workers that are coming in to them.  This is the reason why nursing institutions are composed of nurses that come from different countries.  The trade-off that these nurses have to take is basically, the distant primary group (families and friends) interactions.                There has been a high demand for nurses abroad.  In order to meet this demand, private firms that specialize in health care have proliferated.  Schools have opened colleges of nursing.                For individuals living in Third World countries, they have seen this as the means to get employed.  In one way or another, the rate of inflation is resolved.  The money that comes in the remittances are also contributing to both the micro and macroeconomic performances of these countries.                 (1992) refers to political economy as the ways and means by which the nation-state acts to produce and reproduce itself (p.12).  The concept of the political economy says a lot to nursing and health care.  If we are to look at the history of the practice of nursing, then we will see that nurses or health care specialists are significant in times when nation-states are in war.                In the United States of America during the aftermath of World War II,  University Dean even contended that the American government should act on providing government support towards the profession of nursing.  This can be done through incorporating nursing education in its educational system.  Another is by providing ample government assistance.  Lastly, she argued that nursing education should be built on the baccalaureate degree ( 1990).  The United States of America has a history of nursing shortage as they waged in wars.  This only goes to show how the nursing profession is tied with the country’s political economy.                On the other hand, it may also have to do with the demographics, i.e. when the aging population is high and there is no one to take care of them.  Thus, the governments of countries in these statuses make use of laws to legalize the certain concerns that will meet such demands.  For instance, Canada may refine some laws that pertain to immigration to accommodate the demands of the nursing profession, or allocate a higher expenditure for health services.                These are a few of the basic concepts of economics, which are related and/or applicable to nursing and health care.    The market forces behind the supply and demand of healthcare professionals               When we say demand, we mean the value of a resource, good, or service that an individual or group of individuals are agreeable and have the capacity to buy vis-à-vis the series of prices for a certain phase of time.  The law of demand simply states that the price of a good is indirectly proportional to the quantity demanded of the good (2000).  In other words, consumers need or want products, but they consider the number of products according to their purchasing power.  In accordance with the subject of this paper, nursing institutions in First World countries have a growing demand for nurses.  Likewise, they have the capacity to provide wage premium to their nurses, since the government is providing assistance.  Wage premium therefore is one of the forces that affect the demand of nurses.                Canada, United Kingdom, and the United States of America are said to be suffering from a shortage of nurses.  They depend on 5 developing countries namely, Australia, India, Philippines, South Africa, and Zimbabwe to fill in the demand (2004).                According to Merce (1998), an “increased market demand” is the cause of nursing shortage (2001, June 1, 2006, ).  This further means that quality service is being asked of the nurses.  One does not qualify by simply being a nurse.  One has to be a qualified nurse.  This will be discussed in the succeeding paragraphs.                When we say supply, we mean the value of a good or service in which individuals or group of individuals agree and have the capacity to sell vis-à-vis a series of prices for a certain phase of time.  The law of supply states that the price and the quantity supplied of a good are directly proportional (2000).  For developing countries, in order to fill in the demand, its private firms “supply” nurses by establishing training grounds for them.                       (2004) have found out that a change in wage premium is related to the supply of migrants.  They noted that these are significantly affected by migration costs, working conditions, and living conditions.  These authors are saying that nurses who are planning to be migrant workers in other countries look at the general working conditions or work environment.  They have the autonomy to go where they want to according to where they are at a greater economic advantage.  In this case, the market forces that affect supply pertain to the migration costs, working conditions and living conditions.                The factors that are reported to affect the supply of registered nurses deal with the work environment, recruitment, retention, education, compensation, and recruitment of foreign nurses.  The kind of environment present in clinical settings is such that qualified and experienced nurses find difficulty in dealing with inexperienced ones.  Students in countries where there is a nursing shortage are deemed difficult to recruit in the profession.  Some ways have to be undertaken in order to retain older but expert healthcare professionals.  Efforts should be undertaken to prepare students for a clear understanding of the care environment, ethical knowledge and decision-making skills.  It has been reported that there are nurses who are not compensated enough.  The recruitment of foreign nurses is deemed to serve only the hospitals and not the patients themselves and the domestic nurses, in the case of the United States. ( 2001,  June 1, 2006, ).  These root causes of nursing shortage is true to the case of the United States.  Likewise, these can be considered as the forces that affect the supply and demand of healthcare professionals.                In Australia, nurses are demanding from the government to increase their wages, since they are suffering from a high workload ( 2001).  Wages or compensation and workload seem to be the most common force that affects the supply and demand of health care professionals.  A high workload with a low wage results for most of them to leave their practice, eventually adding the burden of those who are left in the clinical setting.    The economic impacts of current healthcare financing and service delivery on nursing care               One of the perceived economic impacts of the current healthcare financing and service delivery on nursing care is that it paved the way for nursing institutions to deliver quality service to their patients.  They have the necessary resources to engage in activities, e.g., research, that will contribute to the development of the healthcare industry.  It has raised the nursing profession among the rest.                Competition is what drives the economic system.  In order to produce the best of nursing care, healthcare professionals ought to be the best.  They have to deliver a competent service to their clients.  This is actually one of the roots of nursing shortage.  Nursing care is no longer a matter of simply nursing and caring for the patient.  It has gone a step further because of the “increased market demand”, from the term of Merce (1998)  2001, retrieved June 1, 2006,   The role of nurses in the health-care system of the 21st century               Our world today is indeed a world without boundaries.  A certain territory no longer home to a certain social group.  Birds of various breeds live together in one nest.  One of the questions raised in this circumstance is — what is the assurance that nurses who come from different cultural groups will work harmoniously with each other?  An action may be sacred for one while profane to another.  This now opens nurses and other health care professionals to the challenge of cultural competency.  According to  (1998), it refers to “developing an awareness of one’s own existence, sensations, thoughts, and environment without letting it have an undue influence on those from other backgrounds; demonstrating knowledge and understanding of the      client’s culture; accepting and respecting cultural differences; adapting care to be congruent with the client’s culture (2004).    One of the roles of nurses in the health care system in this era therefore is to serve as the promulgators of being culturally sensitive.  They help everyone understand that cultural boundaries do and/or still exist.  The challenge for a foreign nurse is to serve her patient according to the cultural box by which her patient belongs.  On the other hand, nurses can prove or are making way for the possibility of a global culture through their profession.                Another role of nurses in the 21st Century pertains to the utilization of research in the clinical setting.  What caused the proliferation of nurses are said to be the following: the increasing growth of medical and scientific researches, rapid technological progress, and the subsequent growth and development of nursing knowledge and skills ( 1997).  Part of what is being demanded from nurses is being experienced and qualified enough.  Possessing knowledge on the vast nursing research literatures enables them to be categorized as a qualified nurse.  And this is exactly what the health care industry demands from its health care professionals.                            One of the ironies that exist is that despite the various medical breakthroughs, the human race is still experiencing sickness.  A significant role of nurses in the healthcare system is that of encouraging everyone to be conscious of their health conditions.  Vices still infect most individuals, which are hazardous to their health.  Nurses can be agents for the preservation of the human race.    Conclusion               This paper has examined the various forces that significantly affect the problem of nursing shortage in the health care industry.  Changes should take place within these areas that impede the development of health care.  The work environment should be strengthened in order to meet the demands of the nursing profession.

Understanding the Shortage of Nurses in the Light of Economic Concepts

Understanding the Shortage of Nurses in the Light of Economic Concepts ...