Introduction
Patient safety is a fundamental medical principle based on ethical, philosophical, and professional motives. Safety is achieved through many factors, but the medical staff plays a crucial role in achieving an accessible space for the population. The ability to provide comfort and care are principles of medical care that require a conscientious approach to work (“Adverse events, near misses, and errors”, 2019). Nevertheless, patient safety may be threatened by a recent critical problem: staff shortages. The choice of this topic is not accidental; the need has a severe impact on the medical establishment: an increase in deaths, a rate of repeat visits, and an increase in morbidity among physicians and patients (Wise, 2018). The solution to the medical staff shortage lies in improving the quality of education and incentives for existing staff.
Problem Statement: Causes and Effect
In recent years, one of the most acute problems worldwide has been the shortage of medical personnel. The World Health Organization report noted that in 2035 the world would be short of 5.7 million nurses (Shamsi, & Peyravi, 2020). The current distribution of human resources in the U.S. is heterogeneous. Some regions have a surplus of nurses, which relieves hospitals; in others, however, there is a critical shortage of nurses. For New York, only 12.2 nurses per 1,000 population (“The 2021 American nursing shortage: A data study”, 2021). That number is not enough to fully ensure patient safety.
In most Western countries, the extensive increase in the number of doctors and average medical personnel does not solve the problem of staffing. The strategy of structural changes that should provide the correspondence of personnel structure to the real needs of industry and society is becoming increasingly critical (Shamsi, & Peyravi, 2020). The personnel provision (first of all, new approaches to planning and regulation of the personnel structure) determines the content of the educational process, but it influences the structural parameters.
The main reason for the doctor’s resignation in 2020-2022 was difficult working conditions. People were leaving because of the heavy workload: they had to take 70-80 people instead of 20 patients a day (Kishi et al., 2021). Some people quit their jobs because of their age (they were over 65) and because they fell into a risk group. An additional factor was the reluctance or inability to work in the red zone. Thus, some healthcare workers are faced with the need to leave or take paid leave if they cannot move into the red zone as required by their superiors (Kishi et al., 2021). If they have no one to leave their children with to switch to shift work, out of fear of infecting their loved ones or because of their age and the presence of chronic diseases.
Other reasons include the aging of the nursing workforce – science is increasing life expectancy, but the number of people with chronic illnesses is still high. Older nurses are forced to leave because of their condition when the younger generation has not yet fully mastered the skills of care (Yatsu, & Saeki, 2022). In addition, it is noted that there is a significant gap when comparing the salaries of nurses and physicians. It has been reported that nurses are not entirely accepted in the community, causing employees to experience burnout and an inability to continue working (Shamsi, & Peyravi, 2020). Most nurses are women who have children and families in addition to their jobs: they take on extra care and take vacations. Thus, the nursing shortage problem is extensive – various reasons affect patient safety and jeopardize the institution of care.
Philosophy
Patient safety is a fundamental principle in the delivery of health care. Each type, form, and condition of care comes with certain risks to patients. Adverse reactions can arise from any medical intervention, even when adequately performed (whether diagnostic, therapeutic, or rehabilitative). Improving patient safety requires comprehensive solutions within the health care system and a wide range of organizational improvements, including infection control, safe use of drugs and medical devices, safe clinical practice, and a safe environment for care.
Juran’s philosophy is recommended regarding the problem of patient safety, which is compromised by staff shortages. She suggests that quality of service delivery be viewed as a structured approach to planning at the company level rather than the individual employee level. Juran spoke of the quality triad, consisting of quality planning, management, and quality improvement. In shaping the notion of filling the nursing shortage, it is worth applying this theory because it makes a case for continuous improvement. The reality of the pandemic environment has shown gaps in healthcare staffing in organizations due to inadequate working conditions and increased workloads.
Most of the responsibility for restoring lost patient safety falls on the organization, to which the responsibility for replenishing the medical staff is transferred. It is recommended to review implemented support programs, working conditions for nurses, and training sessions. In addition, organizations should develop sets of programs to improve the quality and supervision of duties even in a shortage of staff. In many ways, the challenge for the organization is to rebuild trust between patients and staff and empower medical communication. The ratio of nurses to physicians is currently 0.9 to one, with a required minimum of 2:1 (Yatsu, & Saeki, 2022). The state must intervene to protect the specialties of nursing and midwifery so that we can recruit more candidates to make this profession more desirable for future students.
Organizations, Standards, and Law
The following New York State legislation currently applies to nursing facilities. The New York State Department of Health is committed to determining that nursing facilities meet minimum requirements each year. Among the requirements is an average daily number of hours, which must be adequately allocated to the minimum number of nurses. Sikkander and LaPoint (2022) report that as of April 1, there is a law on minimum staffing levels in nursing homes. Such innovations will standardize the care setting and adjust the workload of nurses.
National Nurses United is the most significant nurses’ union seeking to regulate staff-patient relations. Among the union’s most important proposals are adopting a standard of care for patient safety, preventing employer violence, and increasing funding for OSHA programs. In addition, the Nurse Reinvestment Act, which creates programs to avoid shortages of nursing and integrate leadership programs into training and practice, is currently in effect.
The National Health Service Corps is the leading organization that regulates the healthcare workforce. It is involved in correcting nursing shortages and disseminates information on support programs. Sent to the Senate on May 11, 2021, is the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021 (S.1567 – 117th Congress, 2021). The bill requires organizations to staff hospitals to meet quality standards and incentivize nurses through stipend payments.
Changing and Personal Involvement
One of the questions is material stimulation of the work of medical personnel. A wide range of types of work in the medical sphere, the absence of clear criteria of work efficiency, objective assessment of work quality indexes, and lack of a quantitative index of work measurement – all make it necessary to form the general systematic approaches to the development of a stimulating system of financial remuneration and solution of personnel questions, in particular cadre maintenance of medical institutions. Stimulation of the work of medical personnel for maintenance of high results of their work is a significant problem that can be solved using methods of motivation and the whole system of personnel management.
The development of state-private partnerships in health care could be one of the directions of the solution to personnel deficiency. Public-private partnership is an effective tool for solving several significant social and economic problems, including those contributing to improved quality of patient care and availability of expensive treatment and modernization of information systems, and improvement of medical personnel qualification levels.
Personal involvement in rebuilding the nursing shortage will consist of participation in scholarship education programs. Professional development will address the nursing shortage and reach a more significant proportion of patients. I plan to participate in group nursing support sessions to avoid burnout. I plan to plan my schedule more carefully and distribute my workload wisely and be able to fight back in case of organizational pressure. In addition, I plan to join a union to work with other nurses to develop action plans.
Conclusion
Thus, the shortage of nurses continues to be a problem and hurts patient safety. The reasons for the need are increased workload, lack of social acceptance, burnout, and aging staff. Juran’s philosophy is an opportunity to address this gap through consistent quality improvement. National Nurses United and other organizations offer solutions to the problem: incentives through scholarship programs, professional development, and standardization of work hours.
References
Adverse events, near misses, and errors. (2019). AHRQ. Web.
Kishi, R., Wolfson, A., Lim, M.-G., Stall, H., & Jones, S. (2021). A national emergency: How covid-19 is fueling unrest in the US. Armed Conflict Location & Event Data Project.
S.1567 – 117th Congress. (2021). Congress. Web.
Shamsi, A., & Peyravi, H. (2020). Nursing shortage, a different challenge in Iran: A systematic review. Medical journal of the Islamic Republic of Iran, 34, 8. Web.
Sikkander, N. F. & LaPoint, R. (2022). New York’s nursing home minimum staffing levels law takes effect. BOND. Web.
The 2021 American nursing shortage: A data study. (2021). USAHS. Web.
Wise, J. (2018). Hospital suspends chemotherapy because of nurse shortage. BMJ: British Medical Journal, 363.
Yatsu, H., & Saeki, A. (2022). Current trends in global nursing: A scoping review. Nursing open, 9(3), 1575–1588. Web.