A Power Point Presentation discussing the continued shortage in nursing as patient population and care requirements continue to increase.
Instructor asked us to research and write a short paper on the Affordable Care Act.
It is my understanding from the reading I have done since the Affordable Care Act (ACA) was implemented during the last administration that it may be another step toward socialized medicine. ACA was not named as socialized medicine because in countries where this exists, the entire healthcare continuum falls under the control of the government. Whereas, in the United States, we have what is referred to as Universal Health Care, which allows companies, both profit and non-profit to be managed from within as opposed to being under complete government control. In my opinion, regulation and involvement from the government in just about anything proves unsuccessful. Some examples include, Medicaid, Medicare and Social Security just to name a few. These programs are often times abused by the recipients and politicians, at the expense of the tax payers who, if allowed, may choose to allocate their earnings quite differently. That is not to say there is no use for government. However, this writer feels over involvement may lead to reduced competition among companies striving toward improving or the creation of the next medical discovery.
The website which broke down the Healthcare system overview, Khan, to me was the easiest to understand. The Khan team truly found their niche with the blackboard and colored marker mechanism of educating. People learn in many different ways, and being able to visualize both physically with one’s eyes I feel aids in the mental conception.
The others were all very full of information which made it difficult to find where to begin thus benefiting from the review. It is also humorous to this nurse to see redundant assertions of being an “independent overview not linked to any insurer or political position”, but then often a slanted position is apparent within the dialogue of information provided to the public. It is this ones opinion that were one to be perusing the internet in an effort to learn more about healthcare, the information would prove so overwhelming to many, they may abandon the search. A solution which may appeal to tech savvy consumers would be to offer a “Chat Now” option with subject matter experts at the ready to answer questions and assist prospective people in learning more about this Affordable Care Act.
Being new to the medical field and working in a long term care facility, much of which is private pay, this author has little knowledge or experience where ACA is involved. However, while still in nursing school, I was a home health aide for a local agency and often would hear complaints from the nurses about the challenges they and the patients faced. Obtaining supplies for wound care was one thing I recollect, as many times the nurses would purchase (out of their own pockets!) various supplies necessary for wound care. Another issue was when a home care client would be recertified for continued care, many times unsuccessfully, the nurses were often frustrated with the “hoops they had to jump through”. On the other hand, without the ACA, said client may not have had any coverage at all and once discharged from a hospital or rehabilitation facility, may have been sent home with little or no support to transition back to their normal livelihood.
From the articles by Hassmiller and Spetz, this nurse notes job security in a field that will continue to grow, develop and revolutionize. Being my second career, one of the reasons I selected nursing was for precisely that. Working in retail management for 25 years, one picture became more and more clear as the years passed – innovation and technology were eliminating the need for a brick and mortar building, excessive inventory levels piled on shelves and even the need for subject matter experts employed to educate and teach the consumer. The author Hassmiller listed nine challenges nurses must address to help lead our country in healthcare; nurse led innovation, evidence from research, redesign education, expand scope of practice, diversify, embrace technology, foster collaboration among disciplines, develop leadership at all levels, and be at the table (Hassmiller, 2010). These are foundational themes every organization should implement if they wish to remain vital and relevant. As pointed out by Spetz, the location and landscape of nursing is dramatically changing as well. Outpatient settings such as Ambulatory care and Home Care nursing are two areas where future demand will be increasing (Spetz, 2014, p. 43). Education and ever improved skills will be paramount should an RN wish to remain competitively valued in their chosen specialty. Complacency by a nurse could cause them to fall behind in a rapidly changing profession with cutting edge technology and innovations never before witnessed. Nursing has evolved intensely since the days of Florence Nightingale and will likely continue to change to meet the needs of what is sure to be continual demand.
Although more educated and informed, this writer’s opinion has not changed regarding the ACA. As mentioned in the opening paragraph, government involvement historically has proven to be less than favorable. It is presumed with the disparity among income levels within our country, there need be some sort of healthcare safety net for those who are unable to provide for themselves. Does assistance such as this require legislation and regulation? Well, that bodes another question – we’ve tried that decades – and just exactly how well has that been working?
Hassmiller, S. (2010, September). Nursing’s role in healthcare reform – American Nurse Today. Retrieved from https://www.americannursetoday.com/nursings-role-in-healthcare-reform/
Spetz, J. (2014). How will health refom affect demand for RN’s?. Nursing Economic$, 32(1), 42-43.
American Nursing Association (ANA) statistics project a need of over 1.1 million Registered Nurses by 2022 to fill vacancies and expansion across the ever growing health care continuum (“Workforce,” 2018). The global nursing shortage continues to be a topic of discussion and concern due to healthcare reform. This is an aging population and increases in various specialty categories being filled by nurses. Determining causes and developing action plans to fortify and cultivate registered nurses will be paramount to ensure patient centered care is sustained. Duvall and Andrews (2010) stated, “Recognition that this projected shortage is unlike previous demand-supply imbalances and faced with the looming retirement of a significant portion of the workforce, it is imperative to identify contributing factors based upon current evidence” (p. 310). According to the Bureau of Labor Statistics (BLS), in 2014, registered nurses made up 2.7 million (23%) of the 11.8 healthcare workers within the United States (“Registered nurses”. 2015). The nursing profession continues to evolve year after year. Supply and demand have contributed positively to the nursing profession by increasing available positions, improving salaries, enhancements in scheduling with better flexibility and expansion of advanced practice positions. The purpose of the literature review is to assess the research conducted by others surrounding the nursing shortage in an effort to identify mutual findings which may offer solutions to the complication at hand.
The methods for this literature review were concentrated on reviewing database articles CINAHL, PubMed and Google Scholar. Utilization of keywords to narrow down results were used to include; Nursing Shortage, Nursing Burnout and Causes for Nurse Shortage. Numerous research based and peer reviewed studies were available. The dates of the literature chosen were 2009-2017. Articles selected were from multiple continents, so as to be able to compare and evaluate this topic from a global perspective.
Review of the Literature
A review of the selected literature investigated presented some specific themes. As indicated in Table 1, shortages of nurses seemingly fall into four specific categories which were as follows; Burnout/Exhaustion, Management/Job Dissatisfaction, Attrition/Retirement and Education/Preparation.
Burnout and Exhaustion
Research expresses that burnout and exhaustion are two of the most common reasons nurses continue to turn and churn. When burnout and exhaustion were included as keyword searches with nurse shortage, numerous articles were available which reinforces and validates the existence of said deficiency. Nurses are obligated to work long hours where they are often understaffed. When nursing professionals are continuously pressed to work under these conditions a sense of feeling burned out occurs. This cycle leads to the depletion of nurses in the field.
In a study performed by Guo, Y.F., Luo, Y.H., Lam, L., Cross, W., Plummer, V., and Zhang, J.P. (2017), the authors compared personal resilience to burnout in nurses. The methods used by the authors included self-reporting questionnaires collecting socio-demographics, Maslach Burnout Inventory General Survey, and the Connor-Davidson Resilience Scale. A total of 1,061 nurses completed the questionnaire from six different hospitals. The data was collected from March-June 2015. Authors found that 97% of samples were female with a median age of 29 and a length of service just over 8 years. Approximately two-thirds of the nurses reported that their patient ratio was greater than 10:4. The study identified a person’s resilience could be linked to emotional exhaustion, cynicism and reduced professional efficacy. The literature discussed that burnout and exhaustion are a causal factor for nurses to change careers and leave healthcare altogether. The study conducted by Guo et al. could be used as a platform for nurse managers and healthcare administrators worldwide to take steps to mitigate the global nursing shortage.
In another study on burnout, Chang et al. (2017) gathered data on how burnout can effects professional commitment. The purpose of the authors’ study was to examine burnout in three distinct components: affective, continuance and normative. Methods used to collect data for this study were questionnaires in a single medical center. The qualifiers required to participate were as follows; the nurse be in practice greater than 3 months and full time employment. The facility had 2,322 eligible candidates for the study, however, the grant afforded the inclusion of only 600 participants. The independent variables used were emotional exhaustion, depersonalization, and personal achievement. The authors also collected demographic data to include, gender, age, length of time in nursing, and others. The findings were that of 571/600 samples returned, nearly 91% had been involved in nursing less than 15 years, 99% of applicants were female, and 42% surveyed indicated their patient load between 1-5 patients. In addition to the numerous physical and mental health concerns, the study also indicated burnout can lead to unnecessary and costly turnover for an organization which ultimately leads to increased costs and reduced productivity. Findings support that identifying ways to mitigate nursing burnout may reduce turnover and improve patient outcomes and care levels.
Another review of literature from authors MacKusick and Minick (2010) examined why nurses are leaving their jobs and in some cases the profession. The purpose of the authors’ study in this article was to gather qualitative data surrounding nursing attrition. According to AACN (2003), 30-50% of all new nurses choose to leave the field within their first three years of clinical practice. Methods used by the authors included questionnaires of 10 nurses in practice a minimum of 1 year with no clinical practice in the last 6 months. Only RN’s were selected for this study none of which were in supervisory or educational roles with their prior employer. The researcher interviewed the candidates in semi structured setting. One outcome that links back to both Guo et al. (2017) and Chang et al. (2017) was that fatigue and exhaustion was one of the greatest factors leading to attrition within the nursing profession. Honing in on three common findings, unfriendly workplace, and emotional distress related to patient care MacKusick et al. referenced both of these in the third discovery, fatigue, and exhaustion stating, “working in an unfriendly workplace and being exposed to emotionally distressing dilemmas on a frequent basis was followed typically by insurmountable fatigue and exhaustion” (2010). The authors conclude that nursing burnout and attrition may be avoidable were the appropriate plans put in place to identify nurses, especially new graduates, that may need guidance or support through challenging transitions and emotional complications.
Job Dissatisfaction and Management
Another congruence among the literature reviewed was that the nursing shortage could be due to overall job dissatisfaction and poor perceptions of management/leadership. A negative relationship between a nurse and their career can develop when professionals are overworked. This is also the case when a staff does not favor the management at hand. These two aspects are vital and may be contribute to the shortage happening within the field.
In a review from Duvall and Andrews (2010), the authors conclude, “increasing workloads have the potential to negatively affect both the satisfaction of staff and quality of patient care” (p. 316). Unfortunately, the patient is the one who becomes the victim, when they are supposed to be the principal focus. Multiple articles were linked to dissatisfaction, and poor leadership as contributing to the nursing shortage. As indicated by Homburg, Van Der Heijden and Valkenburg (2013), their study found the key dynamic to correcting the attrition of nurses is to carefully recruit, better develop and further train management and leadership individuals within the healthcare setting.
American Nurses Association notes, “With more than 500,000 seasoned RNs anticipated to retire by 2022, the U.S. Bureau of Labor Statistics projects the need to produce 1.1 million new RNs for expansion and replacement of retirees, and avoid a nursing shortage” (2018). With retirement looming for this large population of nurses, backfilling positions and retaining current nurses will be essential to mitigate predicted outcomes. Characteristics such as job dissatisfaction can be addressed and alleviated with full support from those overseeing the nursing staff. However, it appears there may be some resistance to amend this, as MacKusick and Minick (2010) mention in their literature review that dissatisfaction and a lack of (management) support was documented as far back as 1974 as a cause for nurses to leave the profession.
Education and Preparation
Prior to becoming a nurse, one must successfully complete an education program and in most cases pass a competency examination, similar to NCLEX. Such education programs often include roughly 450 clinical hours, an estimate of 100 exams, and countless hours of studying. Needless to say, completing a nursing program takes time and dedication that prospective students might not be aware of. Following the program, one must pass an examination to show competence in nursing. In the articles reviewed, education and lack of preparation was often identified as a cause for nursing attrition.
In addition to the aforementioned an article from Crow, Hartman and McLendon (2009), the authors point out that a realistic job preview could lead to a reduction in nursing turnover. A person may select nursing as a profession for a number of reasons. However, that does not mean nursing is a good fit for the individual. There is a significant difference between being a good student and being able to perform the daily tasks of a caregiver to another. A question asked to gather data from Crow, Hartman and McLendon (2009) study read as follows, “Before entering nursing school, do students have a realistic view of job requirements and expectations, working conditions, and rewards and frustrations associated with a career in nursing” (p.321)? Response from faculty indicated 65% of the time they disagreed or completely disagreed, indicating the inbound students appear to be unaware of the professions basic expectations.
Once one has become a nurse, furthering one’s education may occur as often as new opportunities present themselves. In addition to daily growth, some nurses wish to broaden their skills and talents moving toward specialty type roles. Nursing shortages may be limiting these nurses the required time to further develop their careers which will ultimately lead to dissatisfaction. This is supported in Homburg, Van Der Heijden and Valkenburg (2013) article, where the authors point out limiting career development opportunities as one of the reasons nurses are choosing to leave the nursing profession (p. 821).
A common theme within the literature reviewed is that the prevailing cohort of nurses is quickly approaching or at retirement age and the pipeline of replacements to backfill vacancies is inadequate. This was clear in a study completed by Buerhaus, Auerbach and Stalger (2009) where they point out up to 30,000 nursing applicants do not obtain a seat in a program due to insufficient faculty or resources to provide the required education.
Researching and reviewing literature around the topic of the global nursing shortage, it is apparent there are many contributing factors to this worldwide concern. The sources were very helpful in targeting numerous isolated issues which appear to be problematic across the geographic plane of the profession. Common factors associated with nursing shortage were as follows; burnout and exhaustion, job dissatisfaction and management, and education and preparation.
Beginning with burnout and exhaustion, the authors (Guo et al.) (Chang et al.) (MacKusick et al.) in the field found mental and physical exhaustion to be leading components. These conditions lead to rapid and costly turnover in the nursing profession. As stated before, AACN explains 30-50% of all new nurses choose to leave the field completely. Nurses are leaving this profession because of the daily exhaustion they encounter adding to the shortage that field is now facing.
Next, authors (Duvall et al.) (Homburg et al.) focused on job dissatisfaction and management. They found that nurses feel overworked, underappreciated, and understaffed. For instance, when a unit is understaffed this causes a domino effect because nurses feel as if they cannot grow within the field. This impacts the attitudes of nurses and their ability to provide patient centered care. Leadership is also a concern for nurses due to the lack of support displayed by management. The lack of training for management influences these problems. Such issues have remained a constant issue with literature dating back to 1974 all relating back to the nursing shortage.
Finally, authors (Crow et al.) (Buerhaus et al.) researched views on education and preparation. It was found that prospective students do not have an appropriate idea of the day to day life of a nurse. Nursing school may not provide the necessary tools, direction, and experiences that students need to be successful. There is also a shortage in nursing faculty, resources, and clinical education institutions which leads to many missed opportunities for both undergraduate and graduate students. The factors listed regarding education and preparation contribute to the nursing shortage.
Finding studies attempting to identify these causes are prevalent, with many honing in on single issues in an attempt to link them to the overall origin. This could prove to be a limitation of the study though, as empirical reviews were often small in sample size, limited to specific populations or geographic location or narrow segments representing the profession i.e. gender, race, etc. More importantly, many of the topics are symptoms of the overall problem, not causes of a nursing shortage. These themes can be reviewed in Table 1 where the sources were synthesized. The question one must ask is, what is the root of the problem or why is there a global nursing shortage?
Table 1: Synthesis of Sources
|Attrition / Retirement||Education / Preparation|
|Buerhaus et al (2009)
|Chang et al (2017)
|Crow et al (2009)
|Guo et al (2017)
|Homburg et al (2013)||X||X|
|MacKisick and Minick (2010)||X||X||X|
Technology and efficacy advancements have in some cases eliminated entire segments of industry and the need for their employ. Contrarily, even with improved efficiency and ever changing cutting edge technology, the nursing profession continues to grow and thrive.
As previously mentioned, research is plentiful identifying symptoms for the nursing shortage both in the United States and abroad. However, few articles accomplished root cause analysis which may be found to start even before a future nurse is selected to enter a nursing program.
Often times when something has been executed the same way for extended periods, the full potential may never be reached due to being caught in a paradigm. One theme within the literature was that schools are not producing enough nursing graduates. Reasons include; inadequate resources, limited faculty (another apparent shortage), and reduction in facilities willing to provide clinical sites for nursing students to gain critical experience prior to licensure. Perhaps it is going to take a revolutionary school or nursing program to make some dramatic revisions, supported by the state and board of nursing, no longer accepting the status quo. Regardless the changes, if they do not include an appropriate job preview within the curriculum, schools will continue to provide seats to a greater amount of students who may choose to not enter the nursing profession or depart quickly and unexpectedly, thus continuing the cycle of the global nursing shortage.
Buerhaus, P. I., Auerbach, D. I., & Staiger, D. O. (2009). The recent surge in nurse employment: Causes and implications. Health Affairs, 28(4), W657-W668. doi: 10.1371hlthaff.28.4
Chang, H.Y., Shyu, Y.L., Wong, M.K., Chu, T.L., Lo Y.Y., & Teng, C.I. (2017). How does burnout impact the three components of nursing professional commitment? Scandinavian Journal of Caring Sciences, 31(4), 1003-1011.doi:10,1111/scs.12425
Crow, S. M., PhD., Hartman, S. J., PhD., & McLendon, C. L., PhD. (2009). The realistic job preview as a partial remedy for nursing attrition and shortages: The role of nursing schools. The Journal of Continuing Education in Nursing, 40(7), 317-23. doi: 10.3928/00220124-20090623-06
Duvall J.J., & Andrews, D.R., (2010). Using a structured review of the literature to identify key factors associated with the current nursing shortage. Journal of Professional Nursing, 26(5), 309-17. doi: 10.10165profnurs.2010.02.002
Guo, Y.F., Luo, Y.H., Lam, L., Cross, W., Plummer, V., & Zhang, J.P. (2018). Burnout and its association with resilience in nurses: A cross sectional study. Journal of Clinical Nursing, 27(1-2), 441-449. doi:10.1111/jocn.13952
Homburg, V, Van Der Heijden, B, & Valkenburg, L. (2013). Why do nurses change jobs? An empirical study on determinants of specific nurses’ post exit destinations. Journal of Nursing Management, 21, 817-826. doi: 10.1111jonm.12142
MacKusick, C. I., & Minick, P. (2010). Why are nurses leaving? Findings from an initial qualitative study on nursing attrition. Medsurg Nursing, 19(6), 335-340. Retrieved from http://ezproxy.emich.edu/login?url=https://search.proquest.com/docview/821544238?accountid=10650
Registered nurses have highest employment in healthcare occupations; anesthesiologists earn the most : The Economics Daily: U.S. Bureau of Labor Statistics. (2015, July 13). Retrieved from https://www.bls.gov/opub/ted/2015/registered-nurses-have-highest-employment-in-healthcare-occupations-anesthesiologists-earn-the-most.htm
Workforce. (2018). Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce
Instructor asked that we write a philosophy paper on what nursing meant to us.
Nursing is a calling, a passion and a profession. Nurses are the conduit between the ever expanding and often overwhelming healthcare industry. A nurse is a voice for the patient in need. The link between diagnosis, treatment and healing. They are the teachers and navigators who guide many from dark terrifying places back toward sunshine and happiness. And when dark scary places are the ultimate destination, a nurse will be the one to support and protect during such turbulent times. Nurses are the field generals responsible for executing a battle plan against disease. The orchestra conductor responsible for timing and tuning all the instruments into an ear pleasing melody. The head coach on the field motivating and inspiring those around them to perform better, be better and feel better. Nursing is important to this writer for many reasons. What other career can one fortify and enrich their own life, help others in need, provide for their family, as well as obtain lifelong learning and endless prospects to grow and develop within a field?
It is the opinion of this writer that a nurse must maintain a long list of values to provide the best patient centered care to include; Benevolence, Universalism and Security. Benevolence would be comparable to the AACN value altruism (“Professionalism and professional values,” 2008, p. 27) where one has a genuine concern and kindness for the health and welfare of others. Universalism would best align with the AACN value Human Dignity and Social Justice (“Professionalism and professional values,” 2008, p. 27-28), as it speaks to understanding appreciating and providing fair treatment to the population and all things unique to each of us. However, Universalism, in this writer’s opinion, expands on that value as it also includes nature which is often in need of nursing care. Finally, security is a value not specifically mentioned in the AACN professional values, and this nurse feels the safety of those for whom we care is nonnegotiable and must lead most decisions surrounding their care.
Just beginning practice in November 2017, this nurse was new to the acute care rehabilitation floor when one client, admitted with a CVA event, was presenting with very concerning orientation. Capturing their vital signs which were significantly abnormal, tachycardia, elevated temperature and low saturated pulse oxygenation, this nurse paged the “on call” doctor, as it was a weekend. What seemed like hours passed waiting for a return call, while one stayed with the patient who continued to decline. When the call came in, the doctor suggested starting an IV and obtaining arterial blood gases as well as some other orders one is unable to recall. Not wanting to disagree with the doctor, but knowing in one’s heart they nor their acute care rehabilitation facility was equipped for what was rapidly becoming a medical emergency, this nurse informed the doctor he was not comfortable with those orders and was going to make a nursing judgment to call for an ambulance shipping the resident to the emergency department stat. The doctor made a comment, along the lines, of “whatever, you’re the one that has to do all the paperwork and readmit in an hour or two when they return…” and ended the call. A few hours later, as requested, the ED charge nurse this one reported the inbound arrival to, returned the call and stated the patient had been admitted to the ICU for another CVA event and had been intubated. As a rookie nurse, it was an overwhelming feeling to realize one had likely just saved the life of another. This also is just one example of how nurses make positive contributions to society each and every day.
What makes a great nurse? How to truly care for another human being, benevolence, prioritization, universalism, and among others the security of others and self are skills one is rarely taught during their nursing education. Abilities like these are refined over a lifetime of repetition and performance. Thousands of nursing students graduate every semester, many with honors and 4.0 GPA’s. However, it is the opinion of this writer that a GPA is no indication of one being or becoming a great nurse. It is the honing of professional values and ensuring we and our coworkers always keep patient centered care at the forefront of our practice and decisions.
Professionalism and professional values. (2008). In The essentials of baccalaureate education for professional nursing practice (pp. 26-28).
Since 1998, 341 terminally ill adults have taken advantage of the legislation in the state of Oregon to end their life with physician assisted suicide (PAS) (“Assisted Suicide Laws In the United States – ERGO,” 2013). In the United Stated, Oregon was the first state to have such a law permitting euthanasia or PAS for terminally ill adults. Since then three other states, Washington, Montana and Vermont, have all passed similar legislation allowing terminal adult patients the right to choose should they wish to end their life via PAS. Globally, four countries have also passed laws in support of PAS or euthanasia; Belgium, Colombia, Luxemburg and The Netherlands allow for end of life decisions (“Euthanasia & Physician-Assisted Suicide (PAS) around the World – Euthanasia – ProCon.org,” 2016). To clarify and differentiate, PAS (in most cases) is administered via medication prescribed by a physician (generally in pill form) which the patient is responsible to ingest. Conversely, euthanasia usually involves a third party and the likely route is injection of a lethal dose of a cocktail to terminate one’s life.
There are several points of contention surrounding the sensitive topic of euthanasia and PAS. Given that many people feel they should have the right to choose how end of life care is managed, others disagree, using words such as “homicide” and “murder” when arguing PAS and euthanasia. As pointed out by Manne et al (2011), autonomy is often the argument from one side while others argue that the value of autonomy is destroyed when one chooses to end their life hence raising points of contention.
An article from the National Center for Biotechnological Information (NCBI) pointed out four non-religions arguments against PAS and euthanasia which were as follows; it is offensive to some patients, pain can be alleviated, creates a slippery slope and jeopardizes physician integrity and patient trust (Sulmasy, Travaline, Mitchell, & Ely, 2016). Since this issue is one of morality and ethics, evidence to support or contrast the subject is rather subjective. End of life decisions in many cases can be quite traumatic for both patients and their loved ones. Just two weeks ago, our family faced the decision to euthanize our six year old dog obtained as a 20 week old puppy. This was our first family pet and the only pet our three teenagers had ever had. When she was found to have a hemangiosarcoma attached to her spleen, one knew her condition was terminal. Alleviating this “family members” pain via euthanasia was difficult, yet simple compared to attempting to explain to three teens why their dog needed to be “put down”, as the humane thing for her.
As was shown in an article by Emanuel et al (2016), evaluating Gallup data as far back as 1947, the authors found that public support (which plateaued in the 1990’s) has remained between 50-70% in support to allowing a patient to decide their end of life method. However, the following is a United States Supreme Court Opinion from 1997 in the case of Washington v Glucksburg:
“The history of the law’s treatment of assisted suicide in this country has been and continues to be one of the rejection of nearly all efforts to permit it. That being the case, our decisions lead us to conclude that the asserted ‘right’ to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause.” (“Top 10 Pro & Con Arguments – Euthanasia – ProCon.org,” 2013)
While public support indicates acceptance of PAS and euthanasia, it is less clear why legislators, including the US Supreme Court Justices, have not moved toward allowing terminal patients their right to choose.
Healthcare providers, to include physicians and nurses can be placed in challenging positions trying to decide what is best for the client yet ultimately maintaining the patients right of autonomy around medical decisions. What is a health professional to do when legislation exists contrary to a patient’s bill of rights? This author feels that attempting to legislate matters involving human life is in violation of one’s dignity and may impose needless suffering both for them and their loved ones which is not the purpose of legislators.
Assisted Suicide Laws In the United States – ERGO. (2013, September 7). Retrieved from http://finalexit.org/assisted_suicide_laws_united_states.html
Emanuel, E., Onwuteaka-Philipsen, B., Urwin, J., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the Unites States, Canada and Europe. Journal of Medical Ethics, 316(1) 79-90. doi: 10.1001/jama.2016.8499
Euthanasia & Physician-Assisted Suicide (PAS) around the World – Euthanasia – ProCon.org. (2016, July 20). Retrieved from https://euthanasia.procon.org/view.resource.php?resourceID=000136
Manne, S., Helgesson, G., Eriksson, S., & Juth, N. (2011, December 8). Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique. Retrieved from https://link-springer-com.ezproxy.emich.edu/article/10.1007/s11019-011-9365-5
Sulmasy, D. P., Travaline, J. M., Mitchell, L. A., & Ely, E. W. (2016, August). Non-faith-based arguments against physician-assisted suicide and euthanasia. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102187/
Top 10 Pro & Con Arguments – Euthanasia – ProCon.org. (2013, December 13). Retrieved from https://euthanasia.procon.org/view.resource.php?resourceID=000126
A unique assignment in a Leadership course as I pursue my Bachelor’s of Science in Nursing was to write a Personal Statement.
The definition of a leader – a person who leads or commands a group. Dating back to childhood, this is the adjective I heard the most when people described me. I have always been an extrovert, go-getter, passionate and energetic about life. Being an only child and around adults most of my young life, I’m sure groomed me for my role as a boss by my first year out of high school. With my peers making college plans, I didn’t have the funds to enter college. Never lacking confidence in myself, I worked my way up the chain of command at the local auto parts store. However, my long time girlfriend, now wife, was the only one who knew my true aspirations of becoming a nurse.
Twenty five years of retail management, working at various powerful companies, all of which included 8 moves in 9 years, proved thankless. For years, I listened to customers complain about appliances not being delivered with a dent or scratch, installers running behind, prices being too high, and the list goes on and on. You would have thought this misfortune was the difference between life and death. All along I knew my true passion but the salaried sixty hour a week job, supported our family. Excelling as a store manager by motivating employees came easy to me. A strong work ethic was engrained in me since childhood. After losing my job in June of 2012, came at a pivotal time in my career and in life. What do I do now? As a man, my role has been to be a good provider and to support our family. Not to mention I had three teenagers watching my every move. Many teachable life lessons came about due to the loss of my employment. The importance of going to college, life isn’t always fair, how to handle disappointment, following your passion are just a few of the discussions I had with my kids. How I handled this life altering event was important for them to see. Do I blame the man who felt my contributions to my long term employer was no longer necessary or do I turn this misfortune into a chance to redefine myself? After much soul searching, I realized the amazing opportunity given to me. My true purpose in life, my desire of becoming a nurse could become a reality.
For the first time in my life, this 250 pound, 6 foot 2, 44 year old fearless man stood before Washtenaw Community College, fearful. A long road ahead, for not only myself, but for my family. Just like every challenge presented in my life, I persevered, taking each new class, each new semester with my head held high as I watched nursing students drop from the program. Approached by two faculty members to help found a chapter affiliated with the National Student Nurses Association then being voted by my nursing peers to become the first ever President was a challenge I gladly accepted. From volunteering at local shelters, collecting 800 coats hats and gloves for children in need, to spearheading community based health awareness clinics and organizing the first ever alumni event from any discipline at WCC, leading the Student Nurses Association with the help of many great individuals was truly a gratifying experience. Working part time jobs as a CNA, carrying the school schedule and adding the nursing association, kept me focused on what I was working towards. The end goal was becoming a college graduate with a nursing degree. The WCC nursing professors had my back every step of the way, encouraging me when the doubt set in. Anatomy and physiology, chemistry, Mother/Baby class and clinical proved to be the most challenging feat. The journey was stressful but giving up has never been in my vocabulary. In fact, after graduating with my class in May 2017, I took the NCLEX 3 times before passing. Humbling is the only word that comes to mind. I have never failed at anything in my life. Whenever I set my mind to something, I always succeed. The NCLEX had me doubting my path. Again, I persevered. Getting my license was satisfying to say the least.
Through being a CNA and now as a nurse working at an assisted living facility, I have found my true calling. Working in geriatrics and taking care of the elderly brings me satisfaction. Treating each of the patients with dignity and compassion proves to be the greatest pride of my nursing career thus far. Knowing I’m making a difference in the end stage of their life, makes all the hard work to get here, worth everything. One thing seems certain, nursing has always been in my blood, I just took a longer road to get here.
One will not often find an interaction with another where at some point during the contact there will be the now familiar ringing, buzzing, chiming or some melodic sound coming from a smartphone. Once tools, these devices have replaced “Best Friends” and “Group Friends”, as the children of today measure their “friend circle” by how many contacts they have on Facebook, Twitter, SnapChat or Insta-gram. However in many instances, there is no human contact with many of these people now referred to as “Friends.” Studies are being done throughout the medical community in an attempt to identify if there is a correlation between the use of these tools and social and emotional development.
Children appear to be losing the ability to talk to one another verbally, as the screen and keyboard have replaced audible and in some instances written communication. Long gone are the days of summer “Pen Pals” or writing a thoughtful note to a relative or friend. These have been replaced by text messages and electronic mail.
Social disconnection becoming a social norm
Researchers at Concordia University in Irvine, Calif., concluded that children born since 1990 have almost 80 percent fewer instances of social interaction in elementary school than previous generations (Hillman, 2014). 80%! While children are in school, they are developing both social and academic skills. If these studies are accurate, appropriate communication both verbally and non verbally will likely suffer in both the short and long term.
It appears as though these devices may also be depriving children of understanding the visual emotions of one another. A 2014 study at University of California Los Angeles selected two groups of 11 and 12 year olds. One group had zero screen time, including television for five days and the other group were allowed to text and tweet normally. The results indicated that the children deprived of electronic screen time showed significantly better abilities to identify with emotions than those using their electronic devices (Kellogg, 2014).
Closer to Home – Local Campground Prohibits Electronics While Child Connects With One Another and Nature
One of the author’s children attends a summer camp each year for two weeks in Napoleon, MI where electronics are strictly prohibited. Based on this, he contacted the camp to discuss their electronic free requirement . When asked the question, “what challenges does the camp face when it comes to running an electronic free facility?” Associate Executive Director of Storer Camps, Brian Frawley said, “we try to teach the campers that technology is not the main focus of camping.” He went on to say that presently there are numerous debates and studies being performed surrounding this topic. Much to his chagrin, he feels it won’t be long before camps are using electronics as a marketing tool offering free wi-fi to their campers. When asked, “Tell me about the camp counselors of today, say the 18-20 year old new hire.” Frawley chuckled and said, “they absolutely lack social skills that the older camp counselors possess.”
In addition to Frawley, the author interviewed a Senior Camp Counselor, Brett Winslow, from this same facility who interacts with the guests every day. Winslow has been involved with the camp for 15 years, 11 as a camper and 4 as a counselor and similar to Frawley, has noted the differences in socialization of incoming summer campers. When asked, how do the children act being without their “best friends” (their smart phones)? Winslow laughed and said, “It is most evident in the first time campers. As a counselor, you can almost immediately identify them, as they have the most trouble connecting and interacting with their peers.” He went on to say, which the author found quite interesting, “But, it’s almost as though the experienced kids can see this isolative behavior as well. Within a couple days, they reach out to those who are not interacting and, should they choose, involve them in group activities. It’s really neat to see the transition for both the new campers and the leadership of the experienced ones.” Does this provide a ray of hope that as consumed as this generation has become with these electronic gadgets, when removed, most can revert back to age old socialization behavior?
When is the right time?
This issue is not limited to school age children and above. Boston University has raised questions surrounding this topic of children as young as 1-3 (toddler age) and completed a study. One scientist asked, of parents using electronic devices to pacify children, “If these devices become the predominant method to calm and distract young children, will they be able to develop their own internal mechanisms of self-regulation?”(Walters, 2015). Additionally, Timothy Cavell, a Psychologist at the University of Arkansas states, “Parents who use phones and iPads as a substitute for their own interactions (with their children) are compromising the development of the attention center of the brain” (Bowden, 2013). Long established techniques of raising children are being abandoned as the results of traditional discipline are not immediately apparent whereas the effects of the tablet or phone are immediate, but in most cases the desired behavior will not be sustained.
When is the right time to introduce electronics to children? As stated in Essentials of Pediatric Nursing, establishment of relationships happens very early on in life where children learn to solve problems associated with relationships. Children learn to give and take, which is more difficult from competitive peers as compared to tolerant adults. They learn the sex role society expects them to fulfill and the approved patterns of behavior. The development of moral values and ethics are closely associated with socialization. Finally, children learn right from wrong, the standard expectations of society and assume responsibility for their actions during these interactions. (In Hockenberry, Wong, & Whaley, 2005, p. 94)
There are many parts of the brain associated with attention to include the Frontal Lobe and the Cerebellum. The Thalamus, a portion of the Limbic system, is located in the center of the brain and plays a critical role with attention span and pain. It likely plays an important role in learning by helping us to direct out attention and to place importance on the right stimulus, thereby being more likely to retain that information (Hillman, 2014).
Cognitive Developmental perspective
Recalling Piaget’s theory, he believed that intelligence was not a fixed trait. Moreover, he pioneered the theory that biological maturation and environmental interactions were the contributing factors toward cognitive development. Conversely, Lev Vygotsky socioculture theory was that important learning occurred from social interactions from a skilled tutor (McLeod, 2014). There are countless resources available at the user’s fingertips, but one has to wonder if these devices are able to be substituted for teachers/tutors?
Education or Entertainment – Risk vs Benefit
With access to the internet, there are countless resources available for education and learning. However, in the case of children, often times the device is used more as a source of entertainment, which can distract and take away from learning. Throughout history, humans have not had a need to be entertained at all times – are these devices taking away this generation’s ability to identify with boredom and more importantly, how to cope with it?
The Good, The Bad and The Mystery
That is not to say that technology and smart phones do not have countless benefits. From being a super computer at one’s fingertips to finding a long lost relative across the globe. Also, who could forget the instantaneous gratification they provide by keeping us all up to date on most anything we wish to inquire about? It is easy to see why these tools have become so addictive and integral in the lives of most. The question is, if the world were to lose its ability to produce enough energy to power these devices – what cost will it be to society when the generations raised on technology cannot Google how to build a fire, cook without a microwave, identify which direction is North or assemble a shelter to keep themselves safe? Which brings us back to the original question; Has technology become a basic human need?
Bowden, W. (2013, December 12). Smartphones bad for children’s social skills? Retrieved March 26, 2017, from http://razorbackreporter.uark.edu/2013/12/smartphones-bad-for-childrens-social-skills/
Hillman, K. (2014, November 17). A List of Brain Areas and What They Do | psychology24.org. Retrieved March 26, 2017, from
In Hockenberry, M. J., Wong, D. L., & Whaley, L. F. (2005). Developmental Influences on Child Health Promotion. In Wong’s essentials of pediatric nursing (7th ed., p. 94). St. Louis, MO: Mosby.
Kellogg, B. (2014, August 27). Study: Smartphones stunting students’ social skills | EAGnews.org. Retrieved March 24, 2017, from http://eagnews.org/study-smartphones-stunting-students-social-skills/
McLeod, S. (2014). Vygotsky | Simply Psychology. Retrieved March 24, 2017, from https://www.simplypsychology.org/vygotsky.html
Walters, J. (2015, February 2). Tablets and smartphones may affect social and emotional development, scientists speculate | Technology | The Guardian. Retrieved March 24, 2017, from https://www.theguardian.com/technology/2015/feb/01/toddler-brains-research-smartphones-damage-social-development
Power Point voice over presentation
Profit will always be a challenge in the healthcare continuum. Healthcare facilities operating expenses are always increasing, meaning cost control projects become more and more important.The control of healthcare expenses falls on each person within the enterprise to not only manage the facilities expenses at an individualized level, but to also strive toward better overall controls for the organization. In this paper, research was performed analyzing supply waste with a simplified solution to reclaim some of these unnecessary expenses.
Turn A $1 Basket Into $100,000,000
In 2011 the Commonwealth Fund reported that approximately one quarter of hospital expenses $215 billion were steered toward administrative costs. US hospital administrative costs are appreciably higher than other nations including; Canada, Germany, Scotland and the Netherlands. Were the US to reduce their spending to that of Canada or the Netherlands, the savings would be greater than $150 billion dollars (“Comparison of Hospital Administrative Costs in Eight Nations: U.S. Costs Exceed All Others by Far – The Commonwealth Fund,” n.d.)
Unnecessary waste within the healthcare industry is frequently studied at the macro level i.e. drug cost increases, marketing expenditures, administrative overhead and hospital employee wages. There are many micro expenses that are overlooked which when scrutinized closely, can add up to significant revenue loss worthy of attention.
In general terms, salaries are the largest expense within most enterprises. Often, when institutions are looking to increase profit, naturally the first category examined is payroll. Economic studies can be done finding short term gains that will calm apprehensive stake and shareholders. Elimination of jobs, benefits or services provided may deliver some short term gains. Although, once implemented, it may be found these draconian methods can result in long term detriments to the service piece of an organization. In the case of a hospital, this would refer to patient care. .
Nurses require several items throughout the day to provide appropriate patient care. A number of these supplies being items that are billable to the patient. A few tools of the trade would include; syringes, alcohol swabs, IV lines, IV caps, tape, wound care items, band aids, IV flushes, just to name a few common items. As with any supply, there is a cost associated for all items involved in patient care.
After completing the first clinical day, when arriving home, one located four alcohol swabs within my scrub pocket. Observing staff nurses the following clinical shifts,, several nurses had collected numerous items on their persons, which one would assume the unused items may have left with them as well. Having a quality improvement assignment due by the end of the semester, observing and attempting to quantify these losses may uncover a significant expense to the institution.
Collecting data the next few clinical days from 3 different nurses per shift, the following results was compiled:
|Overall Cost Analysis (retail) of basic supplies removed from unit||
Average Removed/ Shift
Total $ Per Shift
Total $ Per Year
|IV Cap (1)||$0.50||5||$2.50||$10.00||$490.00|
|Alcohol Swabs (2)||$0.02||3||$0.06||$0.24||$11.76|
|Ink Pen (4)||$0.12||1||$0.12||$0.48||$23.52|
|IV Flush (5)||$0.46||4||$0.84||$7.36||$360.64|
|Annual Results of one nurse working 4 days/wk for 49 weeks||
According to the American Association of Colleges of Nursing (AACN), there are over 3.1 million registered nurses nationwide. It is estimated that approximately 60% of these nurses are employed within a hospital setting, equal to 1,860,000 (“American Association of Colleges of Nursing | Nursing Fact Sheet,” n.d). If we were to assume half of that number, 930,000 were involved with Medical Surgical floors and following the researched data identified, $921.20/yr of lost supplies; that would result in an overall impact of $856,716,000.00! Seems a bit unrealistic, so let’s break it down further. Let’s cut that number of nurses in half, 465,000 and presume the hospital gets a much better deal than the retail price listed, for convenience we will reduce it 50%. With those reductions, the net loss is still $214,179,000!
When asked why the nurses end up taking supplies home, the common theme was, because these items are kept in a location other than the patient’s room. In an effort to improve productivity, did not want to make extra trips back and forth to the patient’s room. Sensible, but costly.
A simple solution to this would be to raise awareness to the staff members of just how costly this problem is across the healthcare continuum. Some suggestions which may mitigate this would be to place a basket near the time clock with a sign reminding employees to “Save Money – Empty your pockets”. These supplies could then be collected and catalogued back where they belong for appropriate use. Another suggestion, a bit more organized, was to place clear plastic bags on a turn style like device where each item could be dropped into the appropriate bag, thus making restocking much more efficient.
A more practical solution, and one being utilized by some hospitals, are the deployment of inner space carts located in each patient’s room. These locking cabinets start at around $600.00 and depending on features increase accordingly. A local hospital utilizes one found online which retails for just under $1000.00. Based on the staggering statistics, $856,716,000.00, that is equal to nearly 860,000 of these carts. These carts would improve other efficiencies within the facility as well; centralize daily supplies required by nurses and other staff members dedicated to patient care, assist with medication distribution as they are locked and aid in infection control, especially in the case of patients under precautions.
When executive decisions are made to cut expenses at the macro level within an organization, short term success may be achieved, but sustainability can be challenging. A simpler solution may be to involve all stakeholders, educating and informing at all levels about simple economics; each time a $0.02 alcohol swab is opened and applied to a patient’s skin, there has to be more than $0.02 in return to counter this expense to the institution.
Some elementary solutions were suggested with very little research to support what may be a significant cost issue within the healthcare field. Were one to delve deeper into some of the most basic processes and procedures currently occurring within the healthcare industry – in many cases one may find that a simple $1 basket can lead to the $100,000,000.
American Association of Colleges of Nursing | Nursing Fact Sheet. (2011, April 12). Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-fact-sheet
A Comparison of Hospital Administrative Costs in Eight Nations: U.S. Costs Exceed All Others by Far – The Commonwealth Fund. (n.d.). Retrieved from http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs
Special Thanks to Brigitte Keyandry for her help with this project and preparation of a fantastic brochure we used to present the above materials
One of the most common interventions in health care are prescription medications. Long term care facilities in particular provide as many as 10-15 medications to a patient to include vitamin and mineral supplements. An article from the National Institute of Health points out that the quality of prescribing has long been criticized about inappropriate prescribing along with overuse of medications not clinically indicated or no longer required (Hughes & Lapone 2011).
In addition to the drug categories which could elicit harm and carry many side and adverse effects, the large quantity of medications many elderly are given, could potentially lead to medication errors. Polypharmacy is the simultaneous use of multiple drugs to treat one or more conditions. A study done in 2004 indicated polypharmacy (greater than or equal to 9 medications) occurred with 40% of the clients within nursing homes (Dwyer, Han, Woodwell, & Rechtsteiner, 2010).
The following are reasons why older adults are especially impacted by polypharmacy:
Renal function with the elderly should be closely evaluated when prescribing any medication. For those elders who appear to have stable kidney function, creatinine lab results can be inaccurate due to reduced muscle mass. To protect against potentially harmful effects of medications, a suggested best practice for prescribers may be to initiate drug therapy at significantly reduced doses and then increase/decrease based on response, side effects and drug levels.
What if we were to break the paradigm? What if when a “new” sign or symptom was present, the health care provider started by ruling out inappropriate medication administration prior to prescribing additional medication? What if when an elder came into a long term care facility, their medications were stopped? Once new baselines were established, re- introduce medication slowly and methodically as symptoms return. We may accomplish a number of things to include; discontinuing unnecessary medications, reducing dosages (or several) which should prove much easier on the patients aging systems and possibly improving their quality of life. Finally, it may reduce or eliminate an undisclosed drug problem in America – inappropriate medication use by the elder population.
Dwyer, L. L., Han, B., Woodwell, D. A., & Rechtsteiner, E. A. (2010, February 8). Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. – PubMed – NCBI. Retrieved February 18, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/20226393
Hughes, C. M., & Lapane, K. L. (2011). Pharmacy interventions on prescribing in nursing homes: from evidence to practice. Retrieved February 18, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110814/
Rochon MD, P. A. (2016, October 11). Drug prescribing for older adults. Retrieved February 18, 2017, from http://www.uptodate.com/contents/drug-prescribing-for-older-adults