Patient Safety in Rural Nursing Because of Nursing Shortage Essay Example for Free

Patient Safety in Rural Nursing Because of Nursing Shortage Essay The United States is in the midst of a nursing shortage that is being increasingly discussed in the context of declining healthcare facilities in the nation. Over 1 in 7 hospitals (15%) report a severe RN nursing shortage with more than 20% of their nursing positions vacant and 80%-85% of hospitals report that they have a nurse shortage This shortage is predicted to intensify over the next decade or two as nurses belonging to the generation of baby boomers retire. The Nursing Management Aging Workforce Survey released in July 2006 by the Bernard Hodes Group reveals that 55% of surveyed nurses and nurse managers reported their intention to retire between 2011 and 2020 (AACN, 2006). In April 2006, officials with the Health Resources and Services Administration (HRSA) released projections that the nations nursing shortage would grow to more than one million nurses by the year 2020 (HRSA, 2003). Nursing colleges and universities are struggling to expand enrollment levels. In the report titled â€Å"What is Behind HRSAs Projected Supply, Demand, and Shortage of Registered Nurses? † analysts show that all 50 states will experience a shortage of nurses to varying degrees by the year 2015 (AACN, 2006). Factors driving the growth in demand for nurses include: an 18 % increase in the population; a larger proportion of elderly persons requiring proportionally higher levels of medical care; advances in medical technology that heighten the need for nurses; an increase in the number of work settings for nurses and demographic changes in an increasing U.  S. population (HRSA, 2003). Factors that are causing a decrease in the supply of nurses are: the declining number of nursing school enrollees, graduates and faculty; the aging of the registered nurse workforce; work environment issues leading to job burnout and dissatisfaction; high nurse turnover and vacancy rates; and declines in relative earnings (HRSA, 2003). Due to this critical imbalance between the supply and demand of nurses, the United States is today facing a nursing shortage crisis. Nursing shortage in rural settings: Research shows that nursing shortage as defined by the federal government exists mainly in rural areas of the country that are far away from metropolitan areas. These areas suffer more from nursing shortage than urban areas due to lack of economic resources to compete with urban based employers, inadequate training for nurses to practice in rural settings and dependence on non-hospital care settings in the rural areas. According to a paper published by the National Clearinghouse for Frontier Communities, â€Å"Impacts and Innovations in Frontier America† (December 2004), nurse shortages in frontier and rural communities derive not only from the current national shortage of nurses but also a long-standing trend favoring rural-to-urban migration of the educated, skilled workforce. There is also the issue of money. When examined by rurality, LPNs in rural settings ($21,941) report an income 23% lower than that reported by LPNs in urban settings ($28,408) (NCSBN, 2006). A large number of rural communities are losing existing employment and education opportunities and the paper suggests that the community context of a nurse shortage can be addressed only through community-based development approaches as well as the crafting of healthy rural policies. The Robert Wood Johnson Foundation published a report titled The American Nursing Shortage with the help of its researchers Bobbi Kimball and Edward ONeil. According to this report, even when some people feel a calling for the professions such as nursing, they are deterred by certain dimensions of the lifestyle, such as low pay, compulsory mobility and the need for service in rural areas. Available data and literature suggest that the impact of the nursing shortage on rural and frontier communities varies greatly from community to community. IN some rural places, there is no difficulty in filling vacancies but there may be just a few good paying jobs. However, in most rural areas, recruiting for openings is estimated to take about 60 percent longer to fill than in urban areas (Long 2000). Nurse employers receive many applications but often find applicants do not meet desired qualifications and then, they often have to accept lower qualifications to fill positions. Differences in education between frontier and non-frontier nurses exist both in their basic nursing education and the highest degree earned (FEC, 2003). Fully half of frontier nurses had qualified as RNs through associate degree (ADN) programs, in comparison with 40% of the non-frontier nurses; in contrast, non-frontier nurses were more likely to have attended diploma or BSN programs. Differences remain when looking at highest degree received; 44% of frontier nurses’ highest degree is the ADN, in contrast with 34% of the non-frontier nurses. And, while the percentage of nurses who have earned a bachelors degree is slightly lower among frontier nurses (30% frontier, 33% non-frontier), the percentage who has earned masters degrees is also lower among frontier (7% frontier compared with 10% non-frontier) (FEC, 2003). At Prairie Vista Nursing Home in Holyoke, Colorado, a town of about 1,900 people about 130 miles northeast of Denver, administrators reportedly had to work double shifts to cover shifts after a nurse retired. Recruiting nurses to work in rural areas is difficult to begin with; and, when urban-trained nurses enter rural practice, they often find they are ill-prepared for the demands of the job, contributing to job dissatisfaction and turnover. Once there, they typically find it difficult to access continuing education opportunities that fit their needs. â€Å"When educators bring their knowledge to us, they often do not realize that we practice differently than urban centers do† (rural nurse, quoted in Molinari 2001). In the rural setting, nurses typically fill multiple roles. There is a need for a broad range of skills and cross training in multiple jobs. â€Å"Rural nursing requires a high level of generalist skills and critical thinking† (Fahs, Findholt et al. 2003). Another issue is that the ethnic composition of the rural nurse workforce does not correspond with the population it serves. The ANA Rural Nursing module identifies five factors that affect rural nursing practice: threats to anonymity and confidentiality; traditional gender roles; geographic isolation; professional isolation; and scarce resources (Bushy 2004). Patient safety for nursing shortage in rural settings: Surveys and studies published recently confirm that the shortage of registered nurses is impacting the delivery of health care in the U. S. and negatively affecting patient outcomes. Research now shows that how well patients are cared for by nurses affects their health, and sometimes can be a matter of life or death. These studies have found that (HRSA, 2003): †¢ A total of 53% of physicians and 65% of the public cited the shortage of nurses as a leading cause of medical errors (Harvard School of Public Health, 2002,); A higher proportion of nursing care and a greater number of hours of care by nurses per day are associated with better outcomes for hospitalized patients (Needleman et al. , 2002); †¢ Nursing actions, such as ongoing monitoring of patient’s health status, are directly related to better health outcomes (Kahn et al. , 1990) ; †¢ 126,000 nurses are needed immediately to fill vacancies at our Nations hospitals. Today, 75% of all hospital vacancies are for nurses (American Organization of Nurse Executives, 2002); Low nurse staffing levels have contributed to 24% of unanticipated events in hospitals that resulted in death, injury or permanent loss of function (Joint Commission of Accreditation of Healthcare Organizations, 2002); †¢ Patients who have common surgeries in hospitals with low nurse-to-patient ratios have an up to 31% increased chance of dying. Every additional patient in an average hospital nurses workload increased the risk of death in surgical patients by 7% (Aiken et. al. , 2002); Low nursing staff levels were a contributing factor in 24% of hospitals’ reports of patient deaths and injuries since 1996 (Joint Commission of Accreditation of Healthcare Organizations, 2002); †¢ Less nursing time provided to patients is associated with higher rates of infection, gastrointestinal bleeding, pneumonia, cardiac arrest, and death from these and other causes (Needleman et al. , 2002); and †¢ Nurse executives surveyed indicated that staffing shortages are contributing to emergency department overcrowding and the need to close beds (American Organization of Nurse Executives, 2002). The Joint Commission on Accreditation of Healthcare Organizations, 2002 has issued a warning that failure to address the problem of nursing shortage in rural areas will result in increased deaths, complications, lengths-of-stay and other undesirable patient outcomes. JCAHO examined 1,609 hospital reports of patient deaths and injuries since 1996 and found that low nursing staff levels were a contributing factor in 24% of the cases (Joint Commission on Accreditation of Healthcare Organizations, 2002). New research indicates that a shortage of registered nurses prepared at the baccalaureate and higher degree level is endangering patients. In an article in the September 24, 2003 issue of the Journal of the American Medical Association, Dr. Linda Aiken and her colleagues at the University of Pennsylvania found that patients experience significantly lower mortality and failure to rescue rates in hospitals where more baccalaureate-prepared nurses provide direct patient care. At least 1,700 preventable deaths could have been realized in Pennsylvania hospitals alone if baccalaureate-prepared nurses had comprised 60% of the nursing staff and the nurse-to-patient ratios had been set at 1 to 4. Unfortunately, only 11% of PA hospitals have more than 50% of the nursing staff prepared at the baccalaureate level ( Institute of Medicine, 2003). A survey titled â€Å"Views of Practicing Physicians and the Public on Medical Errors†, conducted by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation reported in the December 12, 2002 issue of the New England Journal of Medicine found that 53% of physicians and 65% of the public cited the shortage of nurses as a leading cause of medical errors. Overall, 42% of the public and more than a third of U. S. octors reported that they or their family members have experienced medical errors in the course of receiving medical care (AACN, 2006). Nurse researchers at the University of Pennsylvania determined that patients who have common surgeries in hospitals with high nurse-to-patient ratios have an up to 31% increased chance of dying. Funded by the National Institute for Nursing Research, the study found that every additional patient in an average hospital nurses workload increased the risk of death in surgical patients by 7% (AACN, 2006). According to an extensive study by Dr.  Jack Needleman and Peter Buerhas, published in the New England Journal of Medicine in May 2002, a higher proportion of nursing care provided by RNs and a greater number of hours of care by RNs per day are associated with better outcomes for hospitalized patients (AACN, 2006). Conclusion: Available data and literature suggest that the issue of nurse shortage is a national one. Yet, the impact of nurse shortage is better seen in the rural areas where nurses are not well paid, existing nurses are not well qualified and patients are dependent on local medical facilities. Because most frontier and rural communities are distant from hospitals, residents may rely on non-hospital based care settings for a greater proportion of their care than their urban counterparts. Due to these reasons, nurse shortage in rural areas has endangered patient safety. Nurses are the primary source of care and support in the health care sector and hence, a sufficient supply of nurses is critical in providing the national and especially the rural population with quality health care. Nurses are expected to play an even larger role in the future.

Relationships :: essays research papers

QUALITY INTERPERSONAL RELATIONSHIPS A quality interpersonal relationship is a relationship which is built on understanding of self and others. A quality interpersonal relationship goes beyound just being casually aquainted with others to sharing with and gaining an understanding of one another. What I mean by sharing with is that you get a feeling for each other. I can empathize with you and see things through your eyes. When a quality interpersonal relationship is present there's certain amount of synergy that takes place between the persons involved in the relationship. A good example of a quality interpersonal relationship could be found within the strong family unit. If we were to study a family that is close knit what would we see. We would most likely see the following characteristics: individual respect, trust, open lines of communication, open mindedness, patience, empathy, love and many other attributes which add up to a strong interpersonal relationship. With in a strong family you find people that truely feel for each other. For example if Mom is sick the morale of the other family members goes down. If Dad gets a promotion the hold family shares the feelings of esteem with Dad. The point I'm trying to make is that in quality interpersonal relationship you will start to feel some of things that I feel which allows you to better understand me and communicate with me. Although a quality interpersonal relationship sounds like the best thing since Campbell soup and the Gerry-curl it's not a relationship that's easily achieved. To achieve a quality interpersonal relationship takes time, effort, desire, understanding, trust, disclosure, and feedback, effective communication, and etc. When we first meet a person we don't immediately establish an interpersonal relationship. As implied in the opening paragraphs, a quality interpersonal relationship goes for beyound conducting casual conversation. It takes time to build an interpersonal relationship. Why? People like to interact; however, they are protective of there feelings and don't immediately open up to let you inside to see who's live there. What I'm saying is to establish an interpersonal relationship with others you need to know things about them and get some perceptiion of how they interpret things. To get this type of understanding about another person takes time. A good example would be the development of a friendship. Think of your best friend. This is probably one of the most productive inpersonal relationships that exist for you.

Significant Life Event

I have read and understand the plagiarism policy as outlined in the syllabus and the sections in the Student Bulletin relating to the IWU Honesty/Cheating Policy. By affixing this statement to the title page of my paper, I certify that I have not cheated or plagiarized in the process of completing this assignment. If it is found that cheating and/or plagiarism did take place in the writing of this paper, I understand the possible consequences of the act/s, which could include expulsion from Indiana Wesleyan University. Significant Life Event One event in which all involved parties can still laugh about and I believed had brought a significant change to me, and affect me still today. My closest bond I have today it is my relationship with my mother. While our mother-daughter bond has been a blessing we have had the highs and lows of love. There were times when it has been joy and moments which can only be described as maneuvering through a minefield. Most females can relate to this journey through in life. In this relationship, hearts can be broken, feelings can be hurt, and the best intentions can turn a mistake into resentment. With patience and lots of love a mother and daughter can be develop a friendship and a trusting bond strengthened for a lifetime. I can now say as I look back we made a turning point when I was eighteen years old. I had just married my high school sweetheart and the father of my child and had been still living at home with my mother. We are both the oldest child oldest in our family and hence were the example for the younger siblings. We both had plans to make something of our life. We both grew up in an urban area where a teenage pregnancy usually ended a person’s dreams for a better environment. We had considered ourselves adults because we now had a child of our own. But this is hindsight; we thought we had all the answers. My first love and father of child, Robert decided he would enlist in the military and I would finish high school. When he completed boot camp and all the other required training the military deemed for him, his first duty station was thousands of miles away from home. No one could tell me anything about child rearing or the decisions I had made regarding my life. I did not appreciate the help I was receiving from his and my family. With Robert enlisting in the military, we relocated from everyone to start a new life together. By the grace of God his first duty station after boot camp was Hawaii. Most people image Hawaii as paradise on earth, almost anyone including me, at least that was what thought at first. Needless to say when time came near for me to leave I could not wait to get away from my mother’s rules and meddling interfering. My mother and I had differences of opinions on everything, even on the way to the airport until I got on the plane. Once I got to Hawaii to begin my new life, I remember not speaking to her for while except to let her know we made it there safely and besides this was actually a honeymoon for my husband and me. On the day we married he left and I did see him again for five months and we had some cuddling time to make up. Let me tell you once the honeymoon was over and we settled into married life I suddenly realized I was alone with a man who had a life, a job and friends. After I had done all the sight-seeking, daytime television watching, and culture adjustment. I suddenly realized I was home sick and missed my mother. All I had was a two-year-old child that took the word terrible two to another level. The long distant phone calls began and I would call her for the littlest things, from how to cook this recipe, to what are you doing, how to budget and make ends meet, what happened at the last family party or get together and don’t forget to send me pictures of what was going on at home. It hit me that my mother actually knew best, she had the answers from how handle a terrible two year old, why men are the way they are, to why my hair was falling out and skin breaking out. I was miserable with the life we had built and I could blame no one, not even my mother like as I had done so many times before. She was not around and could be blamed for this mess, but she was available by phone and we she would help me figure out what I needed to do to make this work. She suggested that I find something to do with my time, maybe get job, go to school or be more open to social life. I had alienated myself physically from everybody except a husband and a two-year-old child. As time past I adjusted to the island life and developed friendships. A funny thing happened that me, my mother and ex-husband laughs about still today. The situation, reminds me, how much my mother really missed me and how strong our love is. Without our knowledge our home phone was not working properly. We were able to call out but not able to receive incoming calls. This fact was brought to our attention when the military police knock at our door. In my mind at the time a very big official military police officer was looking for my husband. Once he was identified they were inquiring about my where about. The officer said â€Å"His mother-in-law had not heard from her daughter in about a week. † It hit me that my mother had not gone more than a couple days with out hearing from me. Since then my husband was sure we make regular calls home to my mother so the law would not be knocking on our door looking for him. I have a much better appreciation of this relationship with the fact that I now have a grown daughter. I learned later in life the hard way that what comes around goes around. I had my own separation event with my daughter when she moved away for college. But that is another significant life event in its self.

My Personal Experience My Experience As A Teacher

Today, I came prepared to teach my lesson as I was supposed to but times got switched up and plans got changed. In some ways Im glad this happened because it taught me an important lesson of being flexible. As a teacher, things arent always going to go smoothly and on track; there are always mix-ups along the way and learning how to cope with those are imperative. Although I didnt have a chance to teach today, I conducted morning meeting and read some of the book â€Å"Crenshaw† to the class. After, the class and I walked down to the computer room for coding. They just started creating different objects that preform different functions. For example, students chose between a bee, earthquake, dumpster, or car to create and make moveable. I†¦show more content†¦I had small group with my soccer team this morning so came in a little later than usual. Once I got there, I found out we had a sub in the class so knew I had to step up and help to navigate through the lesson pla ns in order to assist her. We first had morning meeting then I read a couple chapters of Crenshaw. After this, I pulled up a video for the sub on what was currently being taught. Following, the students took a quiz what they had learned. The next instruction was to make a foldable on explorers of SC so I helped make a model as what they were expected to complete. While papers were being handed out for this, we realized Mrs. Prioreschi had not printed enough copies so I went to make more. Today was my very last day student teaching with the kids that I consider siblings. When I got to school I gave my teacher and kids their gifts. After that, we went to the computer lab and a coding instructor was there to introduce their next project. I walked around helping students get started on theirs and answered any questions about the problems they ran into. Once we got back to class, I taught my second lesson. The title of it was â€Å"Springing into Christmas,† since the holidays wer e just beginning. Different from the last one, I chose to teach in the English field. It was good of me to switch up the subject that I taught because since I want to be an elementary school teacher, around theShow MoreRelatedMy Experience As A Preschool Teacher862 Words   |  4 PagesMajor Personal Essay: Trust in the Educational Experience How important is trust to the educational process? How does trust between student and teacher impact the experience for both? Over the years, I have sat the chair of both student and teacher, although not typically at the same time! Pondering the topic of trust in the educational experience, I am aware of an internal dialog that is not unlike the Disney Pixar movie, â€Å"Inside Out†. 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