Ethical Nursing Care – Nurse Staffing and Advocacy

Ethical Nursing Care – Nurse Staffing and Advocacy

Ethical nursing care remains one of the foundational frameworks for professional nursing. Notwithstanding, diverse clinical scenarios present considerable ethical dilemmas to nurses and other caregivers. Nurse staffing is one of the areas that may sometimes cause an ethical dilemma. While there is a consensus on the downside effects of inadequate nursing staff on the nurses themselves and the patients and the need to improve nurse-to-patient ratios, the nurses’ action or inaction in an environment of staff shortages may sometimes present an ethical dilemma (Waterfield and Barnason). When there is inadequate nursing staff, shall the facility notify patients and families or keep it quiet? Is it ethical when the nurse has a double caseload and is not able to give the best care to her patients?

Nurse staffing is integral to an effective workforce in healthcare. The position of nurses in the healthcare landscape, coupled with their roles in the patients, makes them valuable to high-quality patient management. Likewise, nurses spend more time with the patients and are more likely to unearth areas of concern in patient management, contributing to health and clinical outcome improvements. This underlined the need for nurses in the healthcare workforce.

Inadequate nursing staff threatens global commitment towards safe, effective, and high-quality healthcare. It has untoward effects on the nurses themselves and the patients. To the patient populations, inadequate nursing staff compromises safety safeguards on patient care. Ball and Griffiths report that poor nurse staffing can result in an increased workload for the nurses and subsequently cause nurse burnout and fatigue. Nurse burnout and fatigue have been linked with poor clinical decision processes, medical and medication errors, and reduced work efficiency of the affected nurses. The overall effects are usually felt by patients, evident in increased hospital readmissions accustomed to medication errors and poor clinical outcomes, longer hospital stay days, and overall increases in the cost of care (Ball and Griffiths). Likewise, medical and medication errors may lower patient satisfaction with the care processes delivered to them. It is, therefore, important that healthcare organizations establish measures to address nurse staffing shortages. Inadequate nursing staff also harms the nurses themselves. Ball and Griffiths report that a high nurse workload causes strain on the nurses and may result in stress, fatigue, and loss of psyche. This predisposes the nurses to healthcare problems such as depression, obesity, cardiovascular disease, needle-stick injuries, and diabetes (Ball and Griffiths). This further underlines the need to address nurse staff shortages.

There is a divergence in thoughts on the role of nurses in addressing inadequate staffing. While some argue that nurses, as advocates, play a role in fronting pertinent changes that improve their welfare and that of their patients, some note that nurse shortages are a system problem that is best addressed by care organizations and healthcare systems. Others also point out that nurses are bound by their professional ethics to provide the best available care to their patients regardless of their working conditions. There is an upside and a downside to all of these thought processes.

Nursing advocacy is one of the roles that demonstrates the expanded space of nurses in the modern healthcare landscape. Nurses, as advocates, are liaisons between the caregivers and the patients. In this capacity, they can identify pertinent concerns within the patient populations and the healthcare workforce and take measures to address them. There is an advantage of nurses having an advocacy voice in healthcare. Having an advocacy voice places nurses in a better position to influence positive changes within healthcare. Advocacy skills also allow nurses to evaluate measures and policies implemented within the healthcare systems that can influence nurses’ operationalizations. In the wake of nurse staff shortages, nurses can lobby for the recruitment of additional nurse staff to offset the shortages. They can also highlight the detrimental effects of inadequate nurse staffing on patient safety to establish a sense of urgency on the matter at hand. Contrarily, nursing advocacy and the power to influence positive changes within care organizations may only be effective in a collaborative front with other healthcare stakeholders. The healthcare systems operate as complex adaptive systems, where each component is interconnected. In such a system, decision-making processes are contextual, relational, and dynamic. In as much as nurses may want to advocate for improvements in nursing staffing, the success of their advocacy may be pegged on whether other healthcare administrators are willing to expand the nursing workforce. This back-and-forth movement has been evident in many societies where nursing shortages are apparent. In such societies, nurses’ call for staff expansion is often downplayed by healthcare administrators, who cite the lack of funds as a barrier to nurse staff recruitment (Ball and Griffiths). This shows that advocacy may not be sufficient in addressing nurse staff shortages.

Advocacy processes may also fail to resolve acute nursing shortages in the short term. Nursing advocacy is a multi-step, protracted process that draws multiple players. Its effectiveness notwithstanding, nursing advocacy may sometimes take a longer time to yield fruits and may not produce an immediate response to the problem of inadequate nursing staff. It is thus considered a long-term solution. The downside of this approach is that the pertinent problems of inadequate nurse staff may persist during the advocacy processes. This further demonstrates that advocacy alone may not be effective in addressing nurse shortages.

A second argument on nursing staff shortages points to the direction of healthcare administrators rather than individual nurses. Healthcare administrators maintain the role of recruiting nursing staff. Notwithstanding, the relational nature of healthcare organizations requires that all players are involved in decision-making processes. In this respect, nurses can play a role in delivering high-quality nursing care. They also play a role in highlighting improvement areas and informing the need for staffing adjustments.

This viewpoint is advantageous in that it points to a possible solution for inadequate nursing staff. In proper healthcare systems, administrators can always assess the nursing workforce, identify the need for additional nursing staff, and recruit accordingly. Healthcare administrator’s responsibility and accountability on this front may help address nursing staff shortages whenever they occur. This may, however, not be true in resource-limited settings. In such settings, healthcare administrators operate on a limited budget against a growing patient population (Waterfield and Barnason). While they may recognize the need for nursing staff expansion, they may not be able to act on it due to a lack of funds.

The ethicality of nurses, in the wake of contentious problems, such as inadequate nursing staff, may sometimes be questioned as opinionated in the third viewpoint. Ethics is a foundational framework of nursing practice. They define the conduct of nurses during their professional practice and guide their decision-making processes. Ethical nursing care upholds patient dignity, fosters a positive relationship building between the patients and their caregivers, and ensures that nurses act in the best interests of the patients (Firouzkouhi et al.). There are diverse viewpoints on nurses’ ethicality in the wake of inadequate nursing staff.

Notifying the patients and families of the nursing shortage is one of the possible actions nurses may take whenever there is an acute nurse shortage. Notifying the patients and families of apparent nursing staff shortages is aligned with the normative ethical principles of non-maleficence, beneficence, and autonomy. The ethical principle of non-maleficence requires that nurses do not harm the patients. This principle implores all nurses to make decisions that may not harm the patients. Inadequate nurse staffing may result in an increased workload and subsequently reduce the work efficiency of the affected nurses (Waterfield and Barnason). In such circumstances, nurses are bound to commit medical and medication errors that have detrimental effects on the patients. It is thus imperative that nurses make decisions that do not put them in a position to make mistakes that harm the patient. Notifying the patients and their families of the staff shortage thus preserves the ethical obligation of non-maleficence.

The ethical principle of autonomy requires nurses and other caregivers to allow the patients to make independent healthcare decisions. In this respect, they should educate them on the possible available options and allow them to decide. The principle of autonomy demonstrates the nurse’s respect and dignity for human life (Firouzkouhi et al.). Notifying the patients and families of the nurse staff shortages shows that the nurses dignify the patients. It shows that the nurses are taking deliberate steps to allow the patient to make an independent decision on whether they can bear the risks of being managed in such an environment or not. It is imperative that the nurses also educate the patients on the potential risks and possible mistakes that may occur whenever they are managed in such an environment (Robichaux et al.). This will allow the patients and families to make an informed decision.

Keeping quiet is another option that may be exploited by a nurse whenever confronted by staff shortages. Nurses owe it to their professional ethical provisions to provide high-quality care to the best of their ability (Waterfield and Barnason). While keeping quiet may signify nurses’ commitment to patient caring, it may have unpredictable consequences for the nurses and the organization. High caseloads are a causal factor for nursing work inefficiencies and have been implicated in several health and safety compromises. It can predispose the involved nurse to significant quality and patient safety compromises. It is thus important that nurses take steps towards self-preservation and avoid actions that predispose them to committing errors.

Maintaining a high nurse workload is unethical. A high nurse workload may push the nurses towards contravening the ethical provisions of non-maleficence that require them not to harm the patients (Firouzkouhi et al.). It is thus important that care organizations take proactive measures to maintain the nurse-to-patient ratio low to prevent nurses from handling double the number of patients they can humanly handle.

High nurse workload remains a risk factor for nursing care inefficiencies. While it is undesirable in healthcare and unethical for nurses to double caseloads, a high nurse workload may be contextual. Several factors result in increased caseloads within the care environment. These include a sudden increase in patient population, as seen in the case of public health disasters, inadequate staff due to a high turnover rate within the hospital, and staff absenteeism, among others (Firouzkouhi et al.). The principle of beneficence requires that nurses act in the best interest of their patients. This may include providing high-quality care to them and promoting their welfare. In the case of inadequate staffing, nurses must scrutinize the case contextually to ascertain the possible cause of the shortage. This will inform appropriate action measures and the need to notify the patients and families of the case. For instance, staff shortages attributed to absenteeism can be addressed by recalling the absent nurses. Likewise, staff shortages due to a sudden spike in patient population can be addressed by nurse mobilization and appropriate scheduling of the available nurses. It is thus imperative that nurses, especially nurse leaders, analyze each situation independently and determine whether the patients should be notified and advised to seek care elsewhere or whether caregivers should keep quiet and activate internal address measures to offset the situation.

Inadequate nursing staff continue to compromise safety and quality safeguards in healthcare. Whenever they occur, they may result in an ethical dilemma for the nurses. Nurses in such cases may have to discern whether to notify the patients about the staff shortage within the facility or keep quiet and provide care to the patients, knowing there is a potential for them to provide suboptimal care to the patients. It is, however, important that nurses analyze each presenting scenario differently and ascertain what is best for the patient.

Works Cited

Ball, Jane E., and Peter Griffiths. “Consensus Development Project (CDP): An Overview of Staffing for Safe and Effective Nursing Care.” Nursing Open, vol. 9, no. 2, July 2021, pp. 872–79. https://doi.org/10.1002/nop2.989.

Firouzkouhi, M., et al. “Ethical Challenges of Nurses Related COVID-19 Pandemic in Inpatient Wards: An Integrative Review.” Ethics Medicine and Public Health, vol. 18, Sept. 2021, p. 100669. https://doi.org/10.1016/j.jemep.2021.100669.

Robichaux, Catherine, et al. “Ethics Education for Nurses: Foundations for an Integrated Curriculum.” Journal of Nursing Education, vol. 61, no. 3, Mar. 2022, pp. 123–30. https://doi.org/10.3928/01484834-20220109-02.

Waterfield, Denise, and Susan Barnason. “The Integration of Care Ethics and Nursing Workload: A Qualitative Systematic Review.” Journal of Nursing Management, vol. 30, no. 7, June 2022, pp. 2194–206. https://doi.org/10.1111/jonm.13723.

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1) State the problem or concept you are going to explore.

2) Develop a thesis statement. “The thesis statement should state the primary goal of your paper. Please use this thesis statement and go from here. When there is inadequate nursing staff, shall the facility notify patients and families or keep it quiet? Is it ethical when the nurse has a double caseload and is not able to give the best care to her patients?

3) The body of your work should focus on one of the issues we have discussed in class.

4) Include outside sources (primary sources)to support your argument or help explore the issue at hand. These materials should be philosophical in nature.

5) In your conclusion, be certain to restate the problem or concept that you explored and summarize your argument
Your topic should be an ethical issue that you are concerned about.