Combating Nurse Fatigue
Public Policy
A1. Public Policy Issue
The public policy for the issue of nurse fatigue is eliminating overtime mandate in the state of New York. The policy will give nurses the authority to choose whether they wish to work overtime or not. It will prevent the major issue that is causing nurse fatigue. Nurse fatigue is the most significant challenge that is affecting the nursing profession; the nurses’ health, productivity, and patient care. Nurse fatigue is physical, mental, and emotional exhaustion after working for an extended period in a high-pressure environment. Overtime particularly mandatory overtime subject nurses to provide continuous care without taking time off to get rest which results in physical, and mental exhaustion.
According to Statherian and Geiger-Brown (2017), nurses that take long hours shifts, overtime experienced more cases of fatigue compared to those that take an 8-hour shift. Statherian and Geiger-Brown (2017) assert that an extended 12-hour shift where nurses work overtime result in low-quality care, increased error, and patient safety issues because of nurse fatigue decreased vigilance. The article explains that this is attributed to the psychological, and physical strain of working long hours in a highly stressful job. Therefore, a measure that ensures nurses get breaks and rest time is essential. The proposed policy will reduce overtimes, and promote the issuance of appropriate shifts where nurses get time off for self-care.
A1a. Selection of Issue
I choose the issue of nurse fatigue because it is a primary problem facing the nursing profession today, and nothing is being done. According to Lindqvist and Tishelman (2015), in the 2017 survey report involving the 257 nurses working in U.S. hospitals, 98% reported that their work is affecting them physically, and mentally, and 85% indicate that their work is causing the fatigue. According to the Bureau of Labor Statistics, 2 million gaps will occur between 2014- 2020 in nursing, promoting the more shortage. Thus, the nurses will be more overworked, and in turn, burnout will continue rising. This clearly shows that nothing will change for the better as far as nurse burnout is concerned. As a result, the nurses’ health is at risk, along with their productivity. When nurses are exhausted, issues like poor patient care, medical errors, and acquired infection grow.
A1b. Issue Relevance
Nurse fatigue is a relevant issue in nursing since it is a problem affecting a significant number of nurses, and nurses have the right to safety at the workplace. Khamisa and Ilic (2015) illustrate that fatigue is an occupational phenomenon that occurs in the workplace with high pressure and workload. It is, however, a high risk in nursing due to the nature of their work that is highly stressful, and there is a staffing shortage. Therefore, it is an issue that directly affects most nurses and the health system in general. Khamisa and Ilic (2015) agree that if the nurses are exhausted with work, it undermines the normal functioning of all hospitals. Hospitals will report high cases of poor patient care and acquired infections. Moreover, the safety of nurses is dependent on addressing nurse burnout. Ríos-Risquez and García-Izquierdo (2016) assert that nurse fatigue undermines their health since it results in the development of psychological problems like depression, anxiety, and also increase their risk of acquiring hospital infections.
A1c. Financial Impact
Supporting the nurses to deter fatigue will require a financial investment by both the hospital and the government. Hospitals will require to fund support services such as counseling, which will assist the nurses in dealing with stress and emotional baggage of seeing patients suffer. They also need to allocate enough funds to ensure they have adequate staff. This encompasses employing and maintaining the required number of nurses. This will address the issue of a nurse shortage, which is responsible for nurse burnout. As for the government, it will need money for the development and implementation of policy concerned with offering relief to nurses and ensuring the workplace is pleasant. The final cost will be for launching the policy, and implementing. This involves include introducing the policy to hospitals, distributing, and analyzing its use in the hospital.
A2. Personal Value
The well-being and safety of nurses is something I believe should be offered to all medical practitioners, especially nurses. As a nurse leader, I take it upon me to promote and advocate for the interest and well-being of nurses. I believe they are self-less people in society who put off their interest to protect everybody and it up to everyone, including me, to defend their safety. This personal value has impacted me to develop personal concern on the issue of nurse burnout since I know it matters that affect the well-being of nurses. In my current workplace, the nurse to patient ratio is 7 patients to one nurse, and mostly nurses are required to work overtime. I observe most of the time the nurses are worn-out by the time they leave for home, and it is common for nurses to develop headache. Thus, I am taking the initiative to eliminate this issue, and improve the nursing field to show gratitude to nurses, and help them increase their productivity.
A2a. Ethical principle.
As a nurse and a Christian, I have ethical principles that guide my behavior. Notably, my strong ethical principle of beneficence supports me in advocating for the need to address nurse burnout. Beneficence is the act of demonstrating kindness, care, and mercy to other people. This moral principle has urged me to do right by nurses; protect, and champion for their right to safety, and well-being. Moreover, the nurses do the same every day when they care for patients.
Policy Brief
B1. Decision Maker
The decision-maker, who will receive the policy brief and spearhead its implementation, is Rebecca Bauer-Kahuna. She is a member in the California State Assembly under the democratic party.
B1a. Explanation
The issue of nurse fatigue is a severe problem that requires the policy, elimination of mandatory overtime to ensure nurses get rest. Nurse fatigue is not only detrimental to nurses but it as well negatively impacts hospitals, and patients. According to Adkins (2018), the extended shifts schedules: mandatory overtime, on-call shifts, and day-nightt rotation are rampant in the nursing field. The author believes that this has created a culture where nurses work long hours or are overworked which, in return, causes nurse fatigue. Adkins (2018) illuminates that 62% of the hospital nurses she surveyed indicated that their medical facilities had mandatory overtime requirement and only a few could refuse despite personal fatigue. The article points out that multiple studies agree that high levels of nurse fatigue are attributed to shift types with mandatory overtime.
Wheatley (2017) agrees that overtime particularly mandatory overtime is prevalent in the U.S nursing field. The article asserts that 60% of the U.S surveyed nurses reported working overtime with 10% working unpaid overtime. It adds that of the reported overtime, more than half of the nurses reported chronic shortage, and worked long hours without breaks. Wheatley (2017) explains that nurses working mandatory overtime is an action to fill the nursing shortage but has an adverse effect. Wheatley (2017) emphasizes that there has been a direct link between nurses working overtime, and nurses’ fatigue, errors, low job satisfaction, and safety issues. When nurses work long hours without rest, they are exhausted to pay attention to their patients, and consequently, there are increased cases wrong dosage, and needlestick injuries.
Thus, this issue requires the attention of Rebecca Bauer-Kahana. She is a member of the U.S assembly tasked with the responsibility of representing the needs of everybody including nurses. If she addresses nurse fatigue, she will promote citizens’ health. Additionally, the decision-maker is a lawyer, and has a history of fighting for the vulnerable, and can champion the implementation of the policy of eliminating forced overtime which will address nurse fatigue. She has a high passion for fighting for the vulnerable people in society. She is renowned for promoting the well-being of immigrants. Rebecca coordinated the legal activities in SFO to aid refugees impacted with the government travel ban, and therefore, she will fight the same for the nurses.
B2. The Challenges
Two primary challenges are likely to impact the implementation of the proposed policy. The primary one is resistance from healthcare. This policy will require sacrifice and investment of resources from medical centers to facilitate the provision of rest time, day-offs and enable employment of enough nurses. They won’t like the idea of channeling more money as it undermines the profitability of the company, which is one of the primary interests of the investors, especially in private hospitals. It will also increase the cost of the hospitals such as payroll. They won’t also be eager to support the implementation of the policy in their hospitals since it will interrupt the way they carry out hospital operations.
The second challenge is enforcing the policy in hospitals. Ensuring all hospitals offer appropriate shift; no mandatory overtime isn’t easy. This is because some hospitals can lie, and cover up records of mandatory overtime. Also, staff won’t come forward to report the issue as they will be afraid of the repercussion of speaking negatively of their employers.
B3. Options/ Interventions
The decision-maker has multiple options when it comes to this issue of nurse fatigue. The first option is approving and issuing a go-ahead for the implementation of the policy of eliminating overtime mandate. After reviewing the policy proposal and identifying it is viable to address the nurse burnout, the decision-maker will initiate the process of making it law that all hospitals will observe. It is a tangible intervention that will directly address this problem. It will ensure all hospitals take measures that ensure the nurses don’t work long hours, and get support to manage work stress. The second option is modifying the proposed policy and then presenting it for approval. If the decision-maker finds the proposal has useful solutions but requires some changes or addition to make it effective, she will sit with the panel and come up with an adjusted proposal that includes hospitals and other individuals’ views. It is also tangible as this option ensures the policy is realistic, and hence it will be accepted by multiple hospitals.
The final option is rejecting the proposal, but acknowledging nurse fatigue is an issue that needs to be addressed. If the policy proposal in unrealistic such costly, and won’t be accepted with the majority of the people, the decision-maker can refuse it. It is also a reasonable intervention since it would reduce wastage of resources of moving it forward while it won’t be implemented. It is rather better to come up with another policy.
B4. Course of Action
The decision-maker will need to take certain courses of action to avert the challenges that can deter effective implementation of policy, and as a result, promote the safety of nurses. The first course of action is gathering all the stakeholders in room after coming up with the policy proposal, and informing hospital representatives, medical unions, nurses, and the health ministry that policy aim to address the issue of nurse fatigue by reducing the number of patients to nurse ,and increasing nurse staff to ease the work of nurses. The decision-maker will also discuss the counselling programs to help nurses manage work stress. She will then inform hospitals that they will play the greatest role of implementing the policy, and it will cause change in the hospital. She will inform the health ministry their role in enforcing it. The decision-maker will also notify nurses, and unions of the importance of keeping an eye on their employers to see the policy is observed. As a result, everyone will be involved, and not sidelined. Fischer and Kraemer (2016) suggest that this will make the hospital feel important, and part of the process, and consequently they will be glad to support it. It also prepares them early enough on what to expect, and as a result, they will accept and implement the policy in the hospitals. This will address both of the challenges, resistance, and difficulties enforcing.
The second course of action is to motivate hospitals. Fischer and Kraemer (2016) suggest giving them incentives for implementing the policy. The decision-maker will give the incentive of insurance companies giving a high rate, and paying promptly to hospitals that comply with the policy. She should likewise show medical facilities the benefits of increased patient care, low nurse turnover, fewer medical errors, and high productivity that comes with this policy. The decision-maker will show reports on the performance of hospitals that have adequate staff, and offer appropriate shift. She will also show PowerPoints in the conference meeting with hospitals about statistics on medical errors, and acquired infections attributable to nurse fatigue. This is to create awareness of the impact of mandatory overtime, and vice versa. This will encourage support from hospitals, and more will implement the policy without being followed.
B5. Evaluation of Success
The success of the proposed policy will be measured by the acceptance of the policy by the decision-maker. It involves the decision-maker accepting to forward the proposal to the California State Assembly that will discuss the proposal and vote on whether to move the proposal to the House of Representatives for passing as a law or not. The voting to pass the proposal will the second way to examine the success of the policy proposal. After it has been passed to the House of Representatives, they will deliberate on it and decide whether it is a good policy. Thus, the vote of the House of Representatives to propose a law will also demonstrate it is a success. The last step in passing the proposal as the law is the signing of the proposal by the president. If the president signs it to become a law, it shows the policy brief is a success.
Also, the positive implementation of the policy by hospitals where they don’t offer mandatory overtime, and consequently employ enough staff, offer a break, and appropriate working hours will determine the success of policy brief. This will, in turn, be marked with reduction or elimination of the following problems, a nurse shortage, nurse turnover, and work fatigue.
The Bottom-Up Approach to Policy Advocacy
C1. Identified Organization or Community
The organization that has expressed concern over the policy issue of combating nurse fatigue is the National Council of State Boards of Nursing. It is an independent and non-profit organization that constitutes boards of nursing of 50 states. It is the agency concerned with public health, safety, and welfare.
C1a. Evidence of Expressed Interest
The National Council of State Boards of Nursing is one of the leading organizations which has shown interest over the issue of nurse burnout. According to Waddell-Goad (2016), NCSBN indicates that nurse burnout is a problem that is affecting patients significantly, and there is a need to address it. The agency believes that nurse burnout promotes patient dissatisfaction in health facilities as nurses are not energetic and focused on providing comprehensive care where they meet both medical and personal needs. NCSBN is urging hospitals and nurses to employ strategies like exercising and getting rest to overcome stress. NCSBN elaborates that new nurses are affected the most with exhaustion, with most reporting feel increasingly stressed. Waddell-Goad (2016) illustrates that NCSBN asserts that new nurses are not able to handle stress as experienced ones. It recommends creating a transition to practice program for new nurses to deter burnout, and consequently minimize safety issues, and errors.
C2. Community-Based Participatory Research
I will employ three CBPR principles when working with the organization to address policy change for the policy issue of nurse burnout. The first one is building on the strengths and resources of the community or organization. The second principle is collaborating well, where there is an equal partnership. The third principle I will utilize is recognizing the community as a unity of identity.
C2a. Approach and Collaboration
Working with the NCSBN will foster the success of the policy change to solve this problem of burnout affecting nurses. Thus, I will approach the president of the agency Julia George, MSN, RN, FRE, and make a good impression where I show her, I have a great interest in this issue and knowledge on the matter. This will be done face to face to appeal to her for support. I will also collaborate with her, and her team throughout the process up to the point of policy implementation. I will come up with convenient ways of interacting. This includes video conferencing, face to face, and emails to communicate with one another.
C2b. Goals Alignment
My goals and the goals of the organization align when it comes to this policy issue. My primary goal is to promote the safety of nurses and patients. Similarly, one of the primary purposes of NCSBN is to improve the safety of the patients and medical staff (National Council of State Boards of Nursing, 2019). Nurse fatigue undermines the safety of nurses and also patients. My other goal is fostering a pleasant working environment where nurses get rest and counseling support. According to Waddell-Goad (2016), the organization has the purpose of promoting the welfare of medical staff, which will constitute ensuring the workplace is fair for nurses. All of our goals are aimed towards addressing issues that cause nurse burnout.
C2c. Action Steps
The first action to achieve the goals mentioned above is forming a team that includes experts and members from the organization who will help to develop an excellent policy to address the issue. The second step is fostering support from various stakeholders; nurses, hospitals’ managers, ministry of health, and nurse’s union. A meeting in a town hall will be organized which will be attended with all the stakeholders mentioned above. In the meeting, the following will be the agenda: examining the nurse fatigue menace, its impact on nurses, patients, and the hospital, how the policy will address the issue, and the policy benefits to the health system. This is to gain funds, authorization of policy, and collaboration from the people who will implement the policy. The next step is researching the issue to come up with interventions to include in the policy. Once the policy has been developed, it will be presented to the House of Representatives to discuss it, and later to the president to be passed as a law
C2d. Roles and Responsibilities
The manager of the policy team will be the president of NCSBN, Julia George MSN RN. She will be in charge of overseeing the whole of the process to ensure everything is going as planned and making authorization. The manager will also perform capacity building; sourcing resources and allocating the funds needed. She will contact non-profit agencies that support nurses, and the government health ministry to fund the project. She will also approve the budget or demand changes in the budget. Lori Scheid will be the outreach person who will act as the contact person for the team and third party. The other roles of the outreach person are maintaining logs, and documents of meetings, and managing the wellness of the group. Mark Majek, Director of the Texas Board of Nursing, on the other hand, will be the supervisor. He will be responsible for recruiting the staff to be involved in policy change development. He will advertise positions to recruit members. He will likewise assign duties by specifying each one’s position and roles based on skills. He also supervises each individual’s work and ensures it done properly. The following problems; a shortfall of staff, disagreement among the team, and poor job performance will be addressed with the supervisor.
C2e. Key Elements of Evaluation Plan
The first principle that will be used is building on the strengths and resources of the community. Our group will be using this principle by identifying our strengths and then maximize them to promote effective policy development. This will promote the achievement of the primary goal of improving the safety of medical staff as well as the patients. The group will know the policy is working if the policy project moves smoothly till its completion.
The second principle that will be utilized is facilitating collaboration through equal partnership. It will be used to foster a good relationship between the group and the stakeholders and the team. It will facilitate the realization of project goals, nurses’ and patients’ safety, and good work the environment. The group will evaluate the success of the principle by looking if there is teamwork among the group and no conflict with stakeholders.
The other principle that will be used is acknowledging the community is the unity of identity. It will be used by identifying the community needs and incorporating them into this project. Applying this principle will support the goal of promoting nurses’ and patients’ safety. The group will know the principle useful by examining the understanding and collaboration of the community with the policy developers.
C2f. Evaluation Organization Plan
I will evaluate the progress of the policy issue by first, and foremost evaluating the response of the group members, and the number of participants involved in the policy development exercise. I will create an open communication where people are free to bring up issues at any time. I will evaluate the complaints, commendations, and remarks of everybody. Positive remarks will show the success of the plan and vice versa. Also, evaluation of the process; development of the team to passing into law will reveal the success of the plan, where I will examine the intended purpose of each step. Similarly, the opinions of stakeholders during the scheduled meeting will show if it is a success.
Evaluate the Effectiveness of the Two Different Approaches
D1. Strengths of Each Approach
Both approaches have strengths. The primary strength of the top-down approach is facilitating quick decision making, which is needed in time-critical problems that require quick responses (Heyden & Ansari, 2017). This will facilitate the quick passing of the policy proposal by the members. The second advantage is promoting observance of guidelines. The team assigned to develop the policy will require regulations that guide on the way things are to be done, and the top-down approach will promote adherence and smooth flow of activities. As for the strengths of the bottom-up approach, the first one is the generation of good ideas as people are encouraged to explore and give views. This will promote the development of effective measures that ensure hospitals eliminate forced overtime. The additional advantage is there is a collaboration among the members of the organization. Thus, the team members involved in policy development will cooperate to facilitate its success.
D2. Challenges of Each Approach
The first challenge of the top-down approach is conflicts within the group. The members feel insignificant to management, and they will have a dispute with them. This will lead to disagreement by hospital representatives with the leaders during policy consultations. The other challenge is poor communication since the people at the bottom can’t offer feedback or information. Hospital representatives won’t have a clear understanding of the issue and will claim their views were not addressed. Heyden and Ansari (2017) elaborate that the main challenge of bottom-up is delayed decision making, especially if a timely decision is needed. It will cause a delay in the completion of policy development and implementation. The second challenge is it is costly since there is the processing of a lot of information and conduction of multiple meetings since everybody should be informed and consulted. This approach can increase the cost of developing this policy.
D3. Most Effective Approach
Bottom-up is the most effective approach to be employed with policy change for addressing nurse fatigue. The policy change will require the support of multiple stakeholders for it to move forward, and this approach fosters cooperation because it promotes communication and trust. This approach will allow rallying of everybody concerned about the importance of this issue, and the need to take initiatives to fight nurse fatigue. Moreover, it will foster acceptance of change among medical facilities to improve their facilities to make them pleasant; not forcing nurses to work overtime, and thus offering rest time.
References
Adkins, M. (2018). Scheduling Practices of Acute Care RN’s and Nurse Fatigue: Assessment and Development of an Educational Program for Nurse Managers.
Fischer, F., Lange, K., Klose, K., Greiner, W., & Kraemer, A. (2016, September). Barriers and strategies in guideline implementation—a scoping review. In Healthcare (Vol. 4, No. 3, p. 36). Multidisciplinary Digital Publishing Institute.
Heyden, M. L., Fourné, S. P., Koene, B. A., Werkman, R., & Ansari, S. (2017). Rethinking ‘top‐down’and ‘bottom‐up’roles of top and middle managers in organizational change: Implications for employee support. Journal of Management Studies, 54(7), 961-985.
Khamisa, N., Oldenburg, B., Peltzer, K., & Ilic, D. (2015). Work related stress, burnout, job satisfaction and general health of nurses. International journal of environmental research and public health, 12(1), 652-666.
Lindqvist, R., Smeds Alenius, L., Griffiths, P., Runesdotter, S., & Tishelman, C. (2015). Structural characteristics of hospitals and nurse‐reported care quality, work environment, burnout and leaving intentions. Journal of nursing management, 23(2), 263-274.
National Council of State Boards of Nursing. (2019). The NCSBN 2019 Environmental Scan. Journal of Nursing Regulation, 9(4), S1-S40.
Ríos-Risquez, M. I., & García-Izquierdo, M. (2016). Patient satisfaction, stress and burnout in nursing personnel in emergency departments: A cross-sectional study. International journal of nursing studies, 59, 60-67.
Sagherian, K., Clinton, M. E., Abu-Saad Huijer, H., & Geiger-Brown, J. (2017). Fatigue, work schedules, and perceived performance in bedside care nurses. Workplace health & safety, 65(7), 304-312.
Wheatley, C. (2017). Nursing overtime: Should it be regulated? Nursing Economics, 35(4), 213.