Inadequate Staffing Ethical Dilemma

(Inadequate Staffing Ethical Dilemma)

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Inadequate Staffing

Nurses play a crucial role in healthcare. The World Health Statistics Reports that over 3.9 million are working in the U. S. (Haddad et al., 2022). Over 275,000 more nurses will be required between 2020 and 2030, per the US Bureau of Labor Statistics (Haddad et al., 2022). The statistics underline the rising demand for nurses while also signifying an existing nursing shortage. In practice, nurses are mandated to facilitate care, ensure patient safety and optimize for better patient outcomes. The practice environment largely determines the ability of nurses to fulfill these roles. Hence, issues that emerge from inadequate staffing, such as high patient-to-nurse ratios, long shift hours, and unconducive working conditions, significantly impact the ability of nurses to deliver safe and high-quality care. The increasing inadequate staffing issues necessitate an analysis of the ethical dilemma that occurs when nurses serve more patients than they can safely provide care to and put patients and staff at risk. (Inadequate Staffing Ethical Dilemma)

Issue of Ethical Conflict

The nursing continuum still struggles with inadequate staff, high turnover, and unequal distribution of personnel. There are various serious reasons for the nursing shortage, including the aging population, aging workforce, nurse burnout, regions, career and family, growth, and conflicts in healthcare settings. Medical errors, heightened mortality and morbidity rates, and nursing shortages correlate (Haddad et al., 2022). Patients have greater death and failure-to-rescue rates in hospitals with high patient-to-nurse ratios, and nurses in these institutions report feeling burned out and unsatisfied. Legislation to regulate patient-to-nurse ratios has started to be adopted in several states. Despite this, when staff shortages, rations increase to accommodate the demand (Haddad et al., 2022). Nurse shortages create an ethical dilemma because they conflict with the application of ethical decision-making principles, nurse values, and moral values. (Inadequate Staffing Ethical Dilemma)

Principles of Ethical Decision Making

Nurses’ commitment to patient safety guidelines enhances care quality and eliminates practice mistakes. According to a World Health Organization report, poor care causes 64 million disability-adjusted life years (Vaismoradi et al., 2020). One of the top 10 causes of disability and mortality is patient harm while providing treatment. Nurses are obligated to ensure patient safety and minimize or eliminate patient harm in short-term and long-term care provisions. Nurses should adhere to organizational strategies to recognize harm and risks through patient assessment, care planning, monitoring, surveillance effort, cross-checking, providing support, and engaging other healthcare professionals (Vaismoradi et al., 2020). Organizations have clear policies, leadership, and research-motivated safety interventions and nurse training to improve adherence, which is critical in preventing medical errors and achieving sustainable and safer healthcare environments.

Still, nurse shortages hinder organization and nursing initiatives to ensure safety and quality of care. Nurse shortages mean that one nurse is attending to more patients than they can handle, increasing room for error and care abandonment. It creates an ethical dilemma because nurses have to go overboard to promote patient safety among all patients. Inadequate staffing also reduces nurses’ time to offer safe patient care (Vaismoradi et al., 2020). It means patient needs like recovery time and emotional and physical needs are inadequately addressed, compromising the nurse’s moral and ethical obligation because of the heavy overload and heightened stress levels. (Inadequate Staffing Ethical Dilemma)

Ethical Responsibilities of Nurses

Nurses tend to ration clinical care and prioritize their initiatives according to their clinical judgment in healthcare environments with nurse shortages. High patient-to-staff ratios force nurses to restrict or neglect nursing care plans, increasing the risk of undesired clinical outcomes. Nursing care rationing effects go against holistic nursing principles and nurses’ ethical responsibilities, including patient advocacy, accountability, and peer reporting, significantly impacting patient care quality. According to Witczak et al. (2021), adverse effects on patient care quality and safety also originate from missed nursing care due to reduced job satisfaction, increased stress levels, heightened burnout, increased absenteeism, and higher staff rotation.

Nursing care rationing is an ethical concern that impacts nurses’ capacity to advocate for their patients. Unsatisfied, burned out, and stressed nurses cannot advocate for their patients at the same levels as nurses caring for fewer patients because they have limited time to understand patient needs that needs advocating for. Inadequate staffing also affects accountability levels and peer reporting or communication between staff members because nurses are forced to prioritize activities and abandon less-priority tasks, leaving them unfinished (Witczak et al., 2021). There is limited personnel to review nursing care and report inconsistencies because prioritizing is given to treating as many patients as possible, and all nurses are preoccupied. Nurse leaders also provide primary care instead of monitoring and supervising nursing activities, reducing accountability and peer reporting. (Inadequate Staffing Ethical Dilemma)

Principles of Ethics

Nurses are obligated to apply principles of justice, beneficence, nonmaleficence, accountability, and autonomy in clinical decision-making. However, the ethical dilemma posed by inadequate nurse staffing conflicts with applying these principles and nurses’ ethical values. For instance, when nurses have more on the table than they can handle, promoting patient-centered care is more challenging, conflicting with the patient’s right to autonomy (Haddad & Geiger, 2018). Nurses should refrain from practices that increase harm and ensure good for all patients. However, care abandonment associated with high patient-to-staff ratios conflicts with the principles of nonmaleficence and beneficence. High patient-to-staff ratios mean that nurses cannot offer a balance of benefits against risks to every patient. Every patient should be treated fairly and equally. Every patient’s interests compete with another patient’s, and nurses should ensure these competing interests are equally and fairly addressed (Haddad & Geiger, 2018). However, treating every patient fairly and equally is challenging when nurses have more patients to care for. Conclusively, high patient-to-staff ratios conflict with a nurse’s integrity and moral character and the application of ethical principles. (Inadequate Staffing Ethical Dilemma)

How Inadequate Staffing might impact Future Practice

The US needs more nurses to address the issue of inadequate staffing caused by factors such as high nurse turnover, a retiring workforce, and nurse educator and faculty shortages. There is also a problem with recruiting and retaining more nurses with the heightening nursing shortages. The problem is expected to worsen by 2030 when about one million nurses retire and vacate the field. Nursing care rationing will increase due to higher patient-to-staff ratios, further complicating future practice. The problem will continue to affect applying ethical responsibilities and principles and nurses’ moral values. However, technologies such as telehealth can help alleviate the effects of the problem by allowing nurses to see more patients in an optimal way by reducing in-person visits that are considered more laborious. (Inadequate Staffing Ethical Dilemma)

Conclusion

Nurses have a duty to promote patient safety and adhere to the ethical principles and moral values that guide practice. However, the inadequate staffing issues conflict with applying these principles, responsibilities, and values because nurses have more patients than they can safely provide care for. In healthcare settings with inadequate staffing, nurses tend to ration nursing care, leading to cases of neglected or abandoned care, adversely affecting patient outcomes and safety. Inadequate staffing is expected to worsen by 2030, and the healthcare system has to devise ways to address the issue before it gets out of hand. Telehealth is one of the approaches that can help reduce the burden on nurses. (Inadequate Staffing Ethical Dilemma)

References

Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations. StatPearls [Internet].

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In StatPearls [Internet]. StatPearls Publishing.

Vaismoradi, M., Tella, S., A Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ Adherence to Patient Safety Principles: A Systematic Review. International journal of environmental research and public health, 17(6), 2028. https://doi.org/10.3390/ijerph17062028

Witczak, I., Rypicz, Ł., Karniej, P., Młynarska, A., Kubielas, G., & Uchmanowicz, I. (2021). Rationing of Nursing Care and Patient Safety. Frontiers in psychology, 12, 676970. https://doi.org/10.3389/fpsyg.2021.676970

 

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