To: Robert Tulman, Chinsia Francis-Hill and Ronda Malabe-Stagias

From: Katie Roberts and SanjidaSadeque

RE: Nurse Staff Shortage on Med-Surg Units in New York

Date: November 10, 2015

The Problem

The issue of nurse staffing levels is an important one that affects the lives of nurses, patients, and the healthcare system at large. We strongly support policy change to address this issue yet it is imperative that the necessity for change is backed by recent data. The statistics provided in the presentation regarding nurse dissatisfaction levels, the levels of the nursing shortage, and the increase in mortality with an increased patient load were all from articles published in the late 1980s and 1990s. While we can agree that nurse staffing levels are important, this data may not sufficient to convince a third party of the issue as it is too outdated. We recommend finding more current sources of data to support your case. Additionally, it would be interesting to see more data from California in regard to patient outcomes, nurse job satisfaction, healthcare expenditures, and patient satisfaction.

Policy Options we Support

The first policy option we support is the implementation of nurse staffing committees. They are of essentially no cost to the institution and can help personalize the problem. They have the potential to allow administrators to see the difficulties that nurses face when they do not have enough staff and can help the nurses build a case for new hires. It can also provide a platform to examine the positive effects of increasing staffing numbers.The idea of half of the committee being comprised of real staff nurses seems to be the key factor to improve the overall situation. A critical factor to be considered here is the distribution of authority between the administration and the nurses in the committee; itshould be clear and precise. There is the potential that nurses propose ideas that may not be viabledueto budget restrictions. Cases like these should be handled carefully; transparency and clear communication must be established among the committee members for this policy to be successful.

The second option we support is having a reserve fund for per-diem and travel nurses. Hiring often takes a long time and these nurses would be essential to filling the gap. Yes, they are a high cost, but this outweighs the losses that could incur with short staffing. Additionally, they are only a high cost for a short amount of time, as they are not meant as a permanent solution. The policy should include clear guidelines about the temporary nurses, their facilities and recruitment process.

Policy Options Needing Amendment

The institution of mandatory nurse staffing levels is the most direct and important way to improve nurse staffing. However, when making policy change in this regard it is essential to include all nurses, not just med-surg nurses. All nursing areas have nursing shortages, not just this unit. By focusing only on med-surg areas this is ignoring a huge nursing and patient population. California has outlined the appropriate staffing level for each kind of unit and this should be replicated since it has shown success. Nurses will not support a change to only one area. By pushing for broader change, it will actually be more likely to be successful as this will garner support from the entire nursing community. Including mandatory staffing levels for all units will have no negative impact towards your focus.

Policy Options we are Against

We do not support the institution of telehealth at this time. Tele-health is actually a tool used to overcome the disparities that exist in rural communities as it redistributes knowledge and expertise to those areas when it is needed. It is an area that is expanding and that has great potential for the future, but it is not at a point where NY should consider instituting it. There is some evidence of success in intensive care units for reducing mortality and increasing the amount of direct patient care time nurses have, but some studies show no benefit (Lustig, 2012). We found no evidence of telehealth being used on a medical surgical unit or in the reduction of sepsis. The article you referenced seems to only suggest telehealth as an ideal – it does not provide any evidence to support its use. If it is implemented, it would mostly serve a purpose in rural hospitals and that purpose would be to improve patient care rather than address nurse staffing.

Tele health as explained in your context is not an easily implementable tool nor does it match the current aims of tele-health. Even if it was implementable, it is simply a bandaid on the problem rather than a solution. The costs needed to implement such a novel type of healthcare would greatly exceed the costs required to hire more nurses and the benefits of the type of telehealth you are suggesting don’t seem to be fully understood or reliable. Funding should go to direct solutions with predictable results.To be optimistic, we would like to recommend the authority to conduct more research in this area for future potential. Long distance and remote service is getting more popular now a days and using Information Technology has its own potential. So instead of implementing telehealth right now, a competitive amount of budget can be allotted for the research in order to come up with a more realistic and achievable solution, which can be implemented in the future.

Alternative Policy Options

Another possible option is to give grants to colleges to start baccalaureate nursing programs or to provide scholarships as an incentive for nurses to pursue a Masters in Nursing Education. This could increase the amount of professors and the amount of training programs to increase the number of nurses in the workforce.As both the policy option we support require new nurses, so it is undoubtedly assumed that we need more training facilitiesalong with increase of capacity of the existing ones to increase the number of both staff and temporary nurses. The paper notes the shortage of training facilities and we agree. Although this is a long-term solution it is no less needed in comparison with the other options. If the training facilities cannot provide the increased number of skilled nurses, the problem will sustain despite of having big funds or strong policies. At the end of the day, it’s the number of qualified nurses and satisfactory patient to nurse ratio that is what is needed and what matters most.

References

Lustig, T.A. (2012). The role of telehealth in an evolving health care environment: Workshop summary. Washington, D.C.: The National Academies Press Institute of Medicine. Retrieved from http://www.nap.edu/read/13466/chapter/1