This essay discusses the importance of nursing skill mix in contemporary healthcare and its impact on patient outcomes. It explores the challenges faced by nurses and the role of assistants in nursing. The essay also highlights the need for proper planning and role definition in implementing skill mix.
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Running Head: NURSING IN CONTEMPORARY HEALTHCARE NURSING IN CONTEMPORARY HEALTHCARE Name of the Student Name of the University Author Note
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1NURSING IN CONTEMPORARY HEALTHCARE Table of Contents Introduction................................................................................................................................2 Discussion..................................................................................................................................3 Conclusion..................................................................................................................................7 References..................................................................................................................................9
2NURSING IN CONTEMPORARY HEALTHCARE Introduction Contemporary healthcare is characterized by two important aspects which include translational medicine and community health. Translational health has find a place in health care as it contributes through biomedical research and the research findings that can be put into practice. On the other hand, community health services demands better health of all populations via both the contextual causes and the interventions of the environment. Thus, there is a greater need for merging the healthcare research from bench to bedside (Waldman & Terzic, 2010). Nursing is that branch of healthcare that deals with patient handling and application of clinical reasoning at times of emergency. Nursing skill mix is a mixture of skills and activities that will be required for taking care of patients and providing nursing satisfaction. Studies have shown that nursing skill mix is related to mortality, hospital ratings by patients, adverse patient outcomes reported by nurses as well as job dissatisfaction of nurses. The process of ensuring good patient outcomes is greatly challenging due to economic reasons as well as health system reforms (Aiken et al.,2017). Hence, it is of utmost importance that nurses include contemporary healthcare strategies in their skill mix to provide complete patient satisfaction as well as to have a desired outcomes. Studies has shown that hospitals should be able to complement the skilled nurses to reduce costs without affecting the patient outcome (Aiken et al.,2017).This can be easily achieved by evidence-based treatment by the nurses that identifies clinical questions and then address these for the effective delivery of healthcare that is easily feasible, effective as well as respects ethical practices of certain communities (Pearson, Jordan & Munn,2011). This essay is going to discuss about the mixing of nursing skills in contemporary healthcare. It also highlights the difficulties that are being faced by the nurses in order to achieve contemporary healthcare. The essay also compares and contrasts the number of experienced
3NURSING IN CONTEMPORARY HEALTHCARE and skilled registered nurses with that of other healthcare professionals. Then the impact of AIN or Assistants in Nursing on skill mix. The affect of skill mix on nurses as well as the possible outcomes from the patients while providing healthcare following skill mix are also discussed in the following sections of the essay. Discussion The use of nurses to deliver quality care comes under a primary care practice. The mixing of skills and staff vary in different institutes as certain countries show very low number of nurses to that of the population count while on the other hand certain countries employ more physicians than nurses (Buchan & Aiken, 2010). The healthcare professionals across the globe have been exploring a lot of ways to skill the staff by mixing adequate number of different healthcare workers (Dubois & Singh, 2009).Studies have shown that nursing skill mix includes a range of methods and procedures that is required to optimize the healthcare sector. It also takes into account the number of personnel or skilled nurses required to provide quality care. There should be improvement in the skills and also the effective use of the skills in taking care of the patients. The use of skilled workers by an organization also needs well defined management of human resources and organizational conditions (Dubbois & Singh, 2009). The ability of the healthcare institutions to provide effective, high-quality, patient centric and safe services depend on the skilled professionals. This is also affected by the shortfall of physicians, nurses, skilled workers and allied professionals. There is shortage of primary care physicians across the globe. Then the high requirement for the services has provided the catalyst for the giving team driven primary care. The skill mix in preliminary care include education, training, tasks along with remuneration of the professionals. Nurses are one of the important non-physician health professionals who work along the doctors. There are clear roles of each members in the primary care team for the optimum patient care. The changes that can be done in primary care skill mix might help to enhance the quality of
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4NURSING IN CONTEMPORARY HEALTHCARE care delivery. It was thought that primary care should be delivered by complete team of physicians and healthcare workers. However, the urgent need of the hour is the integration of the allied health workers under the guidance of nurses and doctors (Freund et al.,2014). The cause of shortage of nursing individuals are numerous and multi-faceted in nature. However, the main reasons that can be the cause of nurse shortage include improper workforce planning, poor recruitment, undersupply, and ineffective use of available sources. The scarcity of health personnel, including that of nurses has become one of the highlighted obstacles in providing effective health services (Buchan & Aiken, 2010). The overall ratio of registered nurses to that of other health workers is declining according to reports of WHO. This ratio is significant as it gives a broad indication on the level of availability of professional nurses in each country. In many countries the low number of nurses are due to the geographical conditions of that place. The countries find it difficult to retain and recruit the professional nurses. The shortage of nurses will lead to a failure in maintaining or improving health care. Nursing shortage is usually the gap between the availability of nurses (Buchan & Aiken, 2010). The better evaluation of the nursing staff can be done by a staffing parameter that will reflect the intensity of care and might enable better evaluation of workload and resources. The shortage in the number of nurses can have an impact over the nurses who are on the job thus, increasing their work load. This ultimately results in decreased morale and job satisfaction (Benson,2016). The lower number of registered nurses can also have an impact on the type of care that is being delivered to the patients. The shortage leads to negative outcomes in patients and lower patient satisfaction as well (Patterson,2011). Thus, to decrease the load on skilled nursing workforce, strategies are developed that would remove the burden without lowering the quality of care. The AIN or the assistants in nursing is well increased after the shortage of registered nurses and their negative impacts. The use of AINs has significantly raised in recent times due to less number
5NURSING IN CONTEMPORARY HEALTHCARE of nurses, cost containment and lower scope of practice for registered nurse. The introduction program of AIN includes session with registered nurses and also delegation and guidance from the skilled nurses.The negative impact of changing the skill mix by reducing the number of registered nurses was restored by addition of AINs to the existing ward. The use of assistants to combat with the nurse shortage is antagonistic with levels of support from policy makers (Twigg et al.,2016). The impact of skill mix on nurses can have a profound effect. As thee is mixing of the new nurses with that of experienced one the new nurses will be able to gain a first-hand experience on the real life situations that they are going to face in the acute care settings of a hospital. This would not have been possible if skill mix would not have been implemented on the AINs due to the shortage of registered nurses. This also helps to reduce the workload of the few remaining registered nurse and also to develop new skills among the assistants in nursing (Masnick & McDonnell, 2010). The healthcare organizations monitor the patient outcomes in order to measure the quality of care and the evaluation of the same. In order to improvethequalityofcarethenursesneedtoknowtheimportanceofdifferent environmental factors. After the implementation of skill mix the quality of the nurses were improved as they learnt to work under a collaborative structure under the guidance of the registered nurse. There was improvement in the nursing practice as well as promoted adequate staffing of nurses. However, there are certain factors that inhibited the entire skill mix program. Cost effectiveness policy and transparency goals are some of the inhibiting factors in skill mix (Kieft et al., 2014). The most important aspect of health care is the patient satisfaction and skill mixing of nurses would greatly have an impact on that. The skill mix of nurses is an important study for the improvement of nursing personnel. Thus to forecast the patient outcome the staffing of hospital nurse and skill mix are important parameters (Twigg et al., 2012). The higher the amount of nursing staff along with a higher skill mix are seen to
6NURSING IN CONTEMPORARY HEALTHCARE be linked with better patient outcomes. The smaller amount of acceleration in skill mix in acute care is seen to be associated with important patient outcomes. Even if the concentration of skill mix is higher favorable patient outcomes is observed. Thus the correct amount of skill mix for registered nurses is 88-90% (Twigg et al.,2012). Patient satisfaction has gained a lot of effective action in order to improve the effective health care. The quality of healthcare affects the patient satisfaction which ultimately influences positive patient behavior. Patient satisfaction is defined as the sole outcome in healthcare.The incorporation of patient’s perception into the assessment of quality of care delivered. The major determinants of patient satisfaction are healthcare settings and staffing of a health care institute. The careful listening along with ease of access to care are the major drivers for the patient satisfaction. Studies have shown that these aspects of nursing are ranked highly by the patients in compared to that of other factors such as physician care, physical environment as well as cleanliness of the institutes. It is also seen that the nurse work and the ratio of patient-nurse staff has significant effects on patient satisfaction and recommendations (Abri and Balushi, 2014). Hence, from the findings it becomes clear that patient satisfaction is a multi-dimensional facet that is affected by a number of variables. Individualized nursing care defines the caring and nursing role. Nursing care is an integrated combination of various nursing activities and ways to improve nursing care. The care provided by the nurses cannot be of high quality if the patient is dissatisfied. However, the excessive mixing of nurses will not be as effective as it sounds. There are certain evidences which suggest that extreme use of low qualified staff is not as effective in all situations, but in some of the cases the extensive use of assistants has caused high amount of organizational effectiveness. There are many scope of extending the nurse skill mix in the healthcare organization. The effectiveness of various skill mixes among various health group workers have enabled the organization to use and explore many role that can be helpful both in favorable patient outcome as well as in coping up with the shortage of
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7NURSING IN CONTEMPORARY HEALTHCARE nurses. There should be balance between the growing population, composition of the healthcare workforce and the workload shared by each of the workers. As the shortage of the nurses leads to overburden the other staffs skill mix is a useful tool that can serve both the purpose of the organization that is it can act as a bridge to fulfill the gap of the effective workers as well as the organization will be benefited by the favorable patient outcome or satisfaction (Masnick & McDonnell, 2010). However, the skill mix changes and the role definitions should be done after the detail analysis as well as the restructuring of the work that is being done by the healthcare team. The new tasks and new teamwork models should include factors that will help them to restructure successfully. The factors include leadership, training along with shared goals between the team members. It should also emphasize in overcoming the resistance from regulators of the workforce, individual practitioners and professional bodies. Studies have shown that progress is possible only if the workforce restructuring is done carefully and is implemented through skill (Bohmer & Imison, 2013). Conclusion Thus, the conclusion that can be drawn from the mixing of contemporary mixing of nursing skills and health care is that the mixing should be done after complete planning and proper defining of the roles of the team members who will constitute the skill mix. The skill mix also helps in reducing the burden on the existing nurse staff due to shortage in the number of registered nurses. As the new nurses are getting a chance to get trained and guided by the experienced nurses in the acute hospital setting they are also getting benefitted as these scenarios are generally not found in the curriculum based knowledge.The other advantages of using nursing skill mix in the healthcare sector is the favorable patient outcome. Patient satisfaction is the most important aspect of the healthcare which is gained by the hospital through staffing resources. The optimization of the nursing skill mix enables the organization to lower their cost as well. It also gives the nurses a higher job satisfaction which in turn
8NURSING IN CONTEMPORARY HEALTHCARE leads to lower staff burnout, resulting in more cost savings. This ultimately leads to patient benefitsbecause increased staff time towards their needs and desires is correlated to the favorablepatient outcome.
9NURSING IN CONTEMPORARY HEALTHCARE References Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., ... & Sermeus, W. (2017). Nursing skill mix in European hospitals: cross-sectional study of theassociationwithmortality,patientratings,andqualityofcare.BMJQual Saf,26(7), 559-568. Al-Abri, R., & Al-Balushi, A. (2014). Patient satisfaction survey as a tool towards quality improvement.Oman medical journal,29(1), 3. Bohmer, R. M., & Imison, C. (2013). Lessons from England’s health care workforce redesign: no quick fixes.Health Affairs,32(11), 2025-2031. Buchan, J., & Aiken, L. (2008). Solving nursing shortages: a common priority.Journal of clinical nursing,17(24), 3262–3268. doi:10.1111/j.1365-2702.2008.02636.x Dubois, C. A., & Singh, D. (2009). From staff-mix to skill-mix and beyond: towards a systemicapproachtohealthworkforcemanagement.Humanresourcesfor health,7(1), 87. Freund, T., Everett, C., Griffiths, P., Hudon, C., Naccarella, L., & Laurant, M. (2015). Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world?.International Journal of Nursing Studies,52(3), 727-743. Kieft, R. A., de Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study.BMC health services research,14(1), 249. Masnick, K., & McDonnell, G. (2010). A model linking clinical workforce skill mix planning to health and health care dynamics.Human resources for health,8(1), 11.
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10NURSING IN CONTEMPORARY HEALTHCARE Patterson, J. (2011). The effects of nurse to patient ratios.Nurs Times,107(2), 22-5. Pearson, A., Jordan, Z., & Munn, Z. (2012). Translational science and evidence-based healthcare: a clarification and reconceptualization of how knowledge is generated and used in healthcare.Nursing research and practice,2012. Twigg, D. E., Myers, H., Duffield, C., Pugh, J. D., Gelder, L., & Roche, M. (2016). The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data.International journal of nursing studies,63, 189-200. Twigg, D., Duffield, C., Bremner, A., Rapley, P., & Finn, J. (2012). Impact of skill mix variations on patient outcomes following implementation of nursing hours per patient day staffing: a retrospective study.Journal of advanced nursing,68(12), 2710-2718. Waldman, S. A., & Terzic, A. (2010). Clinical and translational science: from bench‐bedside to global village.Clinical and translational science,3(5), 254-257. Zboril-Benson, L. R. (2016). Why nurses are calling in sick: the impact of health-care restructuring.Canadian Journal of Nursing Research Archive,33(4).