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Are extended work hours’ worth the risk?

4-One very common area of nursing that is a growing problem is the nursing shortage. “Most studies agree, RNs constitute the largest healthcare occupation, with 2.3 million jobs. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) reports that 126,000 nursing positions are unfilled in hospitals, accounting for an overall vacancy rate of 13% for nursing positions” (Robinson, Jagim, & Ray, 2004). The nursing shortage is a personal and proffesional hazard not only to the nurses, but the patients as well.”If staffing is inadequate, nurses contend it threatens patient health and safety, results in greater complexity of care, and impacts their health and safety by increasing fatigue and rate of injury” (Gooch, 2015). I work in a small ER in California. Now, most people will say, “California has mandated staffing ratios”, but I am here to tell you by experience that that statement is not 100% accurate. There are MANY nights where we are understaffed and over ratioed, with only 3 nurses to triage, asses, start IV’s, medicate, chart, discharge and sometimes  handle multiple codes and traumas in one night. And no, most nights we do not have any ED techs or CNA’s to help with EKG’s, placing people on monitors or any of those types of task. Being short staffed is physically and mentally draining and extreamly unsafe for patient care and overworked nurses. So the question is why is there such a nursing shrotage? Is nursing school/state boards to strict? Is it because the  aging workforce is moving into retirment and into less stressful roles? Is it because of overall job dissatisfaction with the heavy workloads, underpay, and inadequate staffing? All of these could be a reason as to why there is a large nursing shortage and should be further evaluated to help promote nurse and patient safety.

References:

Gooch, Kelly. (2015, August 13). 5 of the biggest issues nurses face today. Becker’s Hospital Review. Retrieved from https://www.beckershospitalreview.com/human-capital-and-risk/5-of-the-biggest-issues-nurses-face-today.html

Robinson. K, Jagim. M, Ray. C. (December, 2004). Nursing Workforce Issues and Trends Affecting Emergency Departments. Lippincott Nursing Center. Retrieved from  https://www.nursingcenter.com/journalarticle?Article_ID=532283&Journal_ID=420955&Issue_ID=532279

 

 

5-One of the most commonly seen errors in the nursing fields
that has become a growing and significant problem, can be seen in patients
being incorrectly administered their medications. All too often, patients are
given the incorrect medications; whether this is due to the nurses who are
administering the medication, the doctors who write out the initial
prescription, or the pharmaceutical workers who fill the prescriptions in the
first place (Keers, Williams, Cooke & Ashcroft, 2013). The errors seen are
not entirely on the medical side of this, as it can be seen that patients can
also incorrectly dose themselves as well (Wright, 2013). Aside from being given
the incorrect dosage of medication, patients can often be given the incorrect
medication in general, or given their medications in either too short, or too long
of a time span (Wright, 2013).

Medical malpractice is an incredible cause of
concern, not only for the issues that can arise from a legal standpoint by
making errors in medication distribution, but from the severe risk of harm
coming to the patient, or even the death of the patient due to receiving a high
dosage of a medication that was incorrectly given (Makary & Daniel, 2016).
Medical malpractice is the third highest cause of death in the United States,
and in order to remedy this dire state of the medical field and for the public
to regain their trust in medical professionals, hospitals must take steps
towards correctly administering their medications (Makary & Daniel, 2016).
This is a role that must be worked at diligently, by not only the nurses at the
facility, but the doctors and pharmaceutical workers as well (Keers et al,
2013).

References

Keers, R. N., Williams, S. D., Cooke, J.,
& Ashcroft, D. M. (2013). Causes of medication             administration errors in hospitals:
A systematic review of quantitative and qualitative        evidence. Drug Safety, 36(11),
1045-1067. doi:10.1007/s40264-013-0090-2

Makary, M. A., & Daniel, M. (2016). Medical
error—the third leading cause of death in the US. BMJ, i2139.
doi:10.1136/bmj.i2139

Wright, K. (2013). The role of nurses in medicine
administration errors. Nursing     Standard, 27(44),
35-40. doi:10.7748/ns2013.07.27.44.35.e7468
 

6- One area that I observed that could be studied more is the long shifts that nurses are required to work. This leads to fatigue and risk of medical mistakes. Industrial research over much of the 20th century indicates worker productivity declines significantly after 10 to 12 hours of work (ANA journal, 2017). A tired nurse is more likely to make errors, putting themselves and patients at risk. Its normal for nurse to work 12 hours shift, however, many times after a challenging 12 hour,s nurses are expected to put in another 4 or so hours when the need arises. Furthermore, many nurses have a long commute home, so they are up for another 6 -8 hours, as they need to take care of their families. After which, possible a few hours’ sleep and back to another long challenging shift. With all this, many nurses are studying and must find time for classes and assignment, which mean less time for rest.  According to U.S. Army studies, staying awake for 17 hours is functionally equivalent to having a blood alcohol concentration (BAC) of 0.05%; staying awake for 24 hours equates to a BAC of 0.10%. (In most states, it’s illegal to drive with a BAC of 0.08% or higher.) It further states that loss of even one night’s sleep can lead to short-term memory deficits and impaired cognitive functioning and the risk of bloodborne-pathogen exposure for workers increases during the last 2 hours of a 12-hour shift (ANA journal, 2017).

Injury risk and the risk for patient error as risen significantly. These risks are not worth the convenience of 12-hour shifts, therefore more studied should be done to highlight the negative effect overwork has on the body and the risk associated with nursing fatigue. The aim is to improve patient safety, nurses’ safety and job satisfaction and not vice versa.

Reference

Are extended work hours’ worth the risk? (2017, November 08). Retrieved from https://www.americannursetoday.com/are-extended-work-hours-worth-the-risk/

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