Nursing | Technical English Essay

Running head: Technical English Essay 1
Technical English Essay
Name
Institution of Affiliation

Technical English Essay 2
The number of nursing staff to the patient population for a while has been an issue of
contention in the US public healthcare system for several decades. As per the U.S Association of
Nurses, “ensuring enough staff numbers in the award is crucial in reducing patient
complications, decreasing nurse exhaustion, reducing nurse lethargy and decreasing number of
mortality cases due to medical errors” ). Nursing staff shortage can lead to adverse consequences
for sick persons such as having a higher duration of stay due to hospital-related problems and
medication errors. It can negatively impact the nursing staff and lead to loss of job morale, nurse
burnout, and fatigue. We will analyze, causal factors for nursing shortage, its implications and
recommend approaches from a perspective of nurse a leader as well as a nurse manager and
administration interventions which can be undertaken to solve this issue in the United States.
Introduction to problem
The number of nursing staff to patient population has been a challenge for several years
in the USA. The consistent increasing need for nurses against the high number of patients has
pushed them to commit medical errors due to exhaustion. Nurses are forced to use a short period
in a single patient because of the pressure put on them by an overwhelming number of patients.
Other issues like forgetting to document crucial information about a patient have also risen.
(Purcell et al., 2011). An example is nurses from California for thirteen years now, they have
been vocal in the fight for an adequate nurse-patient ratio until recently measures were put up to
address their concerns. It has been also proposed that the problem is not only the nursing staff
shortage, but also how hospitals have been planning their schedules have aggravated this issue,
(Lake et al., 2016). In attempt to control organization cost and wages, healthcare facilities have
sought to downscale their nursing staff to profitable ranges as possible. For this reasons health

Technical English Essay 3
institutions can work at a minimum cost regardless of nurse staff to patient population. However,
as health facilities race to adopt this strategy by embracing understaffing, it has a direct negative
consequence on quality of patient care. Both the patient and the individual nurse are exposed to
the risks of this nurse staffing issue. Healthcare institutions and Insurance organizations are
advocating for the need to have shorter hospital stays. To remain aggressive in terms of service
delivery, they have started rendering service of greater delicacy to patients. (Sink et al., 2010
Sequence of events That Led to the Nursing Shortage in United States
Nursing staff shortage started since 1990s in the USA, at the time when use of registered
nurses began. A number of events like a change in technology, health issues and economic
changes together caused a higher demand for registered nurses and consequently a shortage of
them, (Zinn et al., 2012). During this time the healthcare system in US was reshaping due to
changes in technology: changes like start of inpatients required nurses to give ward services to
patients. Also demand for nurses to serve in the military in nursing soldiers was on arise,
therefore depriving public hospitals for civilians further more nurses. These nurses were
anticipated to come back and serve in civilian facilities soon after military activities, but it was
not the case. The situation forced hospitals to start training nurses to cater for the shortage,
(Munier & Porter, 2014). At the time the few nurses who were available were working for longer
time, at a low payment and stressing working conditions. Moreover it was recommended nurses
to stay at the hospital premises, this further made more nurses to opt to work in other sectors.
Recent Causes of Nursing Shortage
Most aspects of the US public healthcare system have been affected by the low staffing
of nurses in healthcare institutions. First the aging population which has been on arise and has
contributed significantly to this problem. The USA does not have enough nurses to care for this

Technical English Essay 4
ever increasing number of old patients who need nurses to take care of them, (Stimpfel et al.,
2012). Besides the ever increasing population of old people, there other factors which have also
contributed to nurse staff shortage: nurse to patient population ratio, inadequate incentive
programs toward nurses, increasing workload and insufficient number and support for nursing
tutors are the five major factors contributing to nursing shortages in the USA. Nurses exhaustion
as a result of workload lead to a high nurse turnover, ultimately resulting in increased operational
cost, (Hinno et al., 2011).
Secondly inadequate incentive programs also have contributed to the low number of
nurses available for service in the nation healthcare set up. Motivational programs should be
adopted in attempt to maintain nurses in public health facilities. Additionally the federal
government should come up with incentives that could motivate more students taking up the
nursing profession. Poor incentives for nurses has been an impediment to retaining nurses in
healthcare facilities. Most have been preferring other sectors which may be offering greener
pastures and better accommodating terms, (Zolot, 2017). Going with the work overload nurses
experience, incentive programs as motivation could assist in retaining nurses in the health sector.
It is a role of nurse managers to ensure his or her employees are well motivated. Availing
incentives such as favorable retirement benefits plan, manageable schedules, higher
compensation, 401K matching, paid sick time and bonus for good work done would reduce
number of nurses quitting the US public healthcare system. Nurses need more time to interact
with their families, and this traditionally they have been getting little time to do so. Often they
are pressured to work in wards for a longer time depriving nurses’ family needs, (Juraschek et
al., 2011). Also it is evident over 55% of US nurses have little access to their employers and are
underpaid in regards to the work they have to do, (Buerhaus et al., 2017). All this challenges,

Technical English Essay 5
together with working with little incentives programs makes the current US healthcare set up to
accommodate more nurses.
Inadequate nursing tutors and training faulty as result of rising number of retiring tutors
and faculty has negatively affected intake new nursing students in training facilities over the
years, ("Workforce supply and demand cause global worries," 2015). According to, (Kreitzer,
2015), number of potential nursing students who have been turned away from training
institutions has been on a constant rise. Nursing profession is an attraction for most students to
enroll in, but the limited number of tutors in training institutions has contributed to nurse
shortages as a few nurses are being channeled to the market comparing the number of patients
they have to handle. An alarming number of nursing tutor vacancy positions has been projected
by 2025 as the most will be retiring form service. Hence need to boost up nursing training system
to ensure continuity of the nursing work force. The lower number of students being admitted into
nursing training schools, means lesser pool nurses is available in healthcare facilities. Similar to
the importance of a sufficient nurse to patient population ratio, the nursing tutor to students is
similar important. It can also be noted when a tutor is overwhelmed by number of students is
handling contravenes the quality of nurses being channeled into the US health market.
As from 2000 the cost of health services has been on rise, and in response healthcare
institutions opted to curtail their nursing staff and adopted overtime working plans to cope up
with the situation. As a consequence the fewer nurses who are available are subjected to nursing
workloads, (Ellis, 2013,). Nurses are forced to use a short period in a single patient because of
the pressure put on them by an overwhelming number of patients. Several nurses are considering
leaving their jobs due to exhaustion. Hospitals also reduced period of stay by a single patient,
making nurse work under pressure too, (MacLean et al., 2014). In a summary a better way to

Technical English Essay 6
solve this problem is improving the nurse to patient ratio, hiring more tutors into nursing training
schools, reducing workload per nurse and implementing better work incentive programs for
nurses.
Healthcare institutions acuity has also contributed to less numbers of nurses compared to
the patient population; the shortening time of patient stay in hospitals and the improving
technology that is permitting, diagnosis, quick assessment and discharge, (Perhats et al., 2012).
Nurses are struggling with the new developments in hospitals in terms of using the sophisticated
technology making them quit nursing at early stages. Healthcare facilities are in need of
specialized nurses due to the increasing number of ICU units and monitored care that requires
assistance from nurses. US hospitals are hiring nurses with baccalaureate degree which a few
nurses in the nation have enrolled, (Ketefian & Redman, 2015).
Another factor which has also contributed to the shortage is the ever aging nursing staff
in US, similar to the rest of the population which is also ageing. About more than half a million
of the nurses in service are approaching retirement, inferring shortage may be on arise within the
next 10 years, (Wu et al., 2016).
Implications
Implications of nursing shortage to the patient and individual nurse
Strained nurses are becoming a problem in United States and low staffing of nurses to
patient population has continually contravened the quality of services provided to patients. In
addition it has endangered the health of nurses who are being strained by a high workload.
Making them more prone to make errors while performing their duties. As stated by, (Thompson,
2012) patients are the most affected by nursing shortage problem as it this directly makes the
quality of patient care to reduce. The consistent increasing need for nurses against the high

Technical English Essay 7
number of patients makes nurses commit medical errors due to exhaustion. Nurses are faced with
a workload that stresses them up. There is likelihood nurses lose morale on their job as a result of
the pressure to deliver within a short time. Consequently the end up giving substandard services
to patients characterized with errors like forgetting to document crucial information about patient
that could result in misdiagnosis. When nursing persist can lead to a spiral of adverse effects:
nurse turnover, absenteeism and exhaustion crops in. This kind of environment contributes to
more nurses quitting the healthcare sector, therefore making the situation worse for the patient.
Patients are forced to stay in hospitals for a longer period and sometimes could be neglected in
wards without care. Moreover, there will be arise in infections, injuries, medical errors and death
in extreme cases of nurse shortage.
Nursing shortage also has a negative effect on patient- nurse relationship. The few nurse
who are available would take little time per patient, reducing the chances of getting to understand
his or her patient well, (Adwan, 2014). Sometime working under pressure may lead to
development of mood swings and emotional exhaustion. Nurse would not be able to respond to
patients appropriately as it required. Patients may decide to look for better services in private
institutions that are offering same services but at higher cost. Generally this makes healthcare
costly to the patient both in terms of time lost and finance.
Another implication of nursing shortage in the US is decreased occupational safety.
Nurses are exposed to more risk and could easily get injured at work. Patients too can injured in
the due to negligence of duties. According to, (Wu et al., 2012), not only the patients are at risk
also a nurse health may be affected. Nurses are to work for longer hours resulting in fatigue and
stress. In this conditions nurses can easily make mistakes which may become serious medical
errors jeopardizing the health of the patient.

Technical English Essay 8
Implications to Nursing Management
Nursing shortages has direct implications on nursing management as they are responsible
for ensuring patients receive quality patient care services. Nurse leaders, managers and even
administrators are required to work together and ensure this problem is resolved, (Harris et al.,
2013).
Proposed solutions
To resolve this problem, it requires appropriate short term and long term measures. It will
take a multi-disciplinary joint effort to take actions which will manage the problem. This will
involve everyone in the nursing sector to play his or her role in attempt to place measures to
solve this issue. It will require individual nurses, nurse leaders, managers, administrators, federal
government and even other interested parties joint effort. According to, (Dotson et al., 2012) a
solution for nursing shortages in the USA is complex than just recruiting more nurses. It will be
achieved by making into consideration of several variables through aggressive and multifaceted
decisions. Besides to increasing number of nurses to patient population, several other studies
have suggested different interventions such as nurses being allowed to hold non-degree
certificates contrast to traditional way of nurses having Bachelor degree certificates and
introducing non-magnet hospitals in addition to the magnet ones, (Chen et al., 2013). Generally
research has shown improved patient care has been achieved when nursing staff is sufficient in
regard to patient population.
A better way to correct this challenge is by the nursing management ensuring an adequate
number of nurses is available in relation to the patient population (Iglesias et al., 2013). Soon a
nurse-patient ratio has been agreed on, the management should make an effort to sustain this
nurse-patient ratio. The federal and legislative arm of government should also chip in to support

Technical English Essay 9
this initiative by formulating acts of laws that are in support of this policy. Creating policies that
ensure not only this ratio is maintained but also support staff for nurses is hired to help in taking
care of patients per hospital. Also, effort should be made to ensure the transition of nurses from
the more experienced one to juniors and interns is efficient. This ensures at any given time there
is a leadership vacuum that will exist in the ward (Paixão et al., 2015).
Nurse Leader Approach
Individual nurses themselves are leaders and guide their fellows. Some of the roles of a
nurse are to ensure the safety and upheld rights of a patient. Nurses can also come in to help his
or her fellow nurses in terms of helping duties or articulating their needs on behalf of them.
Nurses are advocates and leaders by nature. Therefore nurses team up to ensure all is well within
hospital units. A nurse leader may initiate teamwork amongst his juniors in decision making to
outline the challenges they are facing in regards to the nurse-patient ratio (Johansen et al., 2019)
Most of the nurses across almost all states have recognized this issue and tried to
articulate so it could be solved. An example is nurses from California for thirteen years now,
they have been vocal in the fight for an adequate nurse-patient ratio Nurses across the country
have seen unsafe staff nurses to patient ratios and have raised their voices. There is now a bill in
the senate about this issue which could compel the federal government to issue a safe nurse-
patient ratio is adhered to. The Nurse Staffing Standards for Hospital Patient Safety and Quality
Care Act (S.1063), and one in the U.S. House of Representatives, The Nurse Staffing Standards
for Hospital Patient Safety and Quality Care Act (H.R.2392) that urges nurses to write to their
congressman to support this legislation.

Technical English Essay 10
Nurse Manager Approach
A nurse manager could solve the nursing staff ratio issue differently from how a nurse
leader could handle. Nurse Managers play a bigger role in which they oversee a larger group of
staff members. They are mostly involved in ensuring the well working of the hospital as a whole:
make sure or departments are functioning properly and even improving staff numbers to the
population of patients being received. Nurse Managers have challenges in ensuring this ratio is
adequate due to financial constraints to meet this demand. They are concerned with profit,
therefore, could prefer a lesser number of nurses.
Nurse Managers may prefer to approach this by calling for more additional funding to the
health set up from State or advocate for keenness within the unit. The keenness of both patient
and current nurses will reduce the number of errors made within the hospital, (Yankovic and
Green, 2011). This approach will save on the energy of the available nurses because they are
spared from exhaustion, fatigue and burn out due to mistakes and overwork. Though keenness in
wards as an approach by managers to solve this issue may not solely work out, (Castle and
Anderson, 2011). Nurse Managers may opt for other mechanisms like looking for financial aid to
employ more staff.
Administrative approaches addressing nursing shortage
Even though funding towards the nurse-patient ratio is a delicate issue, is one best
approach on how the nurse-patient ratio issue can be solved. These funds are supposed to be used
in equipping nurses with more knowledge of patient care. Therefore for an efficient nurse-patient
ratio, there is a need for enough staff in hospital units. The Health Resources and Services
Administration (HRSA) has been involved in offering programs and financial assistance to
improve access to medical services by patients. This institution has majorly invested in activities

Technical English Essay 11
about nursing education, raising the number of nurses in service, motivating nursing work staff
and improving patient care through funding.
Moreover, institutions like the Association of American Nurses have been providing
scholarships to facilitate the education of students interested to be nurses at higher institutions of
learning. This institution is campaigning for more nurses in the economy hence improved nurse-
patient ratio. Some of the funds from ANA go to help activist groups involved in pushing this
agenda of more nurses in wards. Though the all process of training and enumerating nurses takes
a considerably longer period, costly, and might vary state to state, it’s evident that this process is
the only way patient demands could be met. (Duffield et al., 2011). A small number of nursing
staff could be overwhelmed by the work posed by patients due to lethargy. This cumulatively
increases the cost of managing a health institution due to periodic errors made or the need to hire
contract nurses to cater to the shortage, and expensive ordeal in the long term.
Another potential strategy to solve the nursing shortage issue is by improving on
recruitment process of new nurses. The Federal and state government should use a policy which
allow recruitment of given number of new nurses each state, (Wyte-Lake et al., 2013). A
program that will allow hiring of more nurse intern in each health facilities is necessary. There is
also need to improve the nursing training programs as a solution to the nursing shortage. Most of
the nurses in service have their 2-year degree from community colleges. Several students are not
able to get practice nursing as they end not pursuing a graduate program to enable them take up
nursing jobs. Community colleges should be supported so that they can prepare nursing students
who are ready to take jobs as soon as they graduate from these institutions. Community colleges
should be accredited to able to give licenses and ready to work training to their students. Hence
the will be no need for nursing students to pursue graduate programs in order to be ready to do

Technical English Essay 12
professional duties. Though some states have adopted this strategy as an effort to solve the
shortage problem, there is need for more states to follow suit in implementing it. Rural regions
will benefit much from this program as mostly these areas do not have graduate universities,
(Yankovic and Green, 2011)
A higher percentage of younger generation in the USA is attracted to healthcare sector,
and this is true in the nursing sector. However few of them are accepted to join nursing schools
as result of few vacancies being available, (Castle & Anderson, 2011).To solve inadequate nurse
numbers in the current healthcare system, it is necessary to nursing schools such that they are
able to admit more students who have qualified for nursing programs. More nursing faculty
should be hired into these schools. Experienced nurses who have gone through doctorial
programs are supposed be motivated to take roles as nursing faculty to train more nurses in the
US. Faculty nurses should be given incentives such as competitive salaries, there important role
in the sector appreciated and given rewards from time to time. This will in turn attract more
doctorial nurses to assume tutoring roles in nursing schools. In addition, the AACN has outlined
a number of suggestions to solve this problem such as using non-nursing schools to conduct
certain nursing training programs as a short term measure to save on cost and time. Considering
training nurses outside the academic set up on the benefits of progressing in their nursing careers
and also permitting retired faculty to continue training for an extended period.
According to, (Duffield et al., 2011)) the following suggestion can be implemented such
that to increase interest in nursing sector. All stakeholders in the nursing field need to pull
together in finding a quick fix for the shortage of nursing staff. Nursing professionals should
advertise the nursing profession, explaining the importance, need of taking it as a career choice.
They need to develop an attractive image regards to being a nurse in the society. This should

Technical English Essay 13
ensure nursing is seen a first priority by prospective students who could shadow the few nurses
available in some duties as shadowing has been applied in other sectors successful. Managers
can also be ambassadors for nursing profession through backing for fellow nurses and
convincing others to join the nursing sector, (Sink et al., 2010).
Recommendation for further research
It is will be necessary to evaluate professional culture of nursing in order to understand
how to solve what seems as though to be a culture of workload in nursing. Perhaps, assuming the
entire nursing US sector could engage itself in a self-reflection, and get to know why still most
nursing staff continue to work in what could be said an exploiting and oppressing environment,
the administrators maybe at a better position to solve nursing shortage problem.
Conclusion
Overall from my findings nurses in the USA are overworked, and this has a negative
implication on patient care, individual nurse and patient safety. Whatever the reasons behind
nursing shortage, it is evident nurses are likely to commit medical errors and jeopardize patient
safety when they are overworked. The nursing staff shortage is a problem that needs a quick
fixation in the U.S health care system. A solution to this issue will lead to improved nurse-patient
care and a better health system as a whole. Patients will get quality service and also nurses will
be contented and get to enjoy their work. Generally, this improves service delivery to patients
and a health system that is working better to deliver its vision of healthcare for all.

Technical English Essay 14
References
Adwan, J. Z. (2014). Pediatric nurses' grief experience, burnout and job satisfaction. Journal
of Pediatric Nursing, 29(4), 329-336.
Buerhaus, P. I., Skinner, L. E., Auerbach, D. I., & Staiger, D. O. (2017). Four challenges
facing the nursing workforce in the United States. Journal of Nursing Regulation,
8(2), 40-46.
Castle, N. G., & Anderson, R. A. (2011). Caregiver staffing in nursing homes and their
influence on quality of care. Medical Care, 49(6), 545-552.
Chen, P. G., Auerbach, D. I., Muench, U., Curry, L. A., & Bradley, E. H. (2013). Policy
solutions to address the foreign-educated and foreign-born health care workforce in
the United States. Health Affairs, 32(11), 1906-1913.
Dinsdale, P., & Parish, C. (2003). Overwhelming support for minimum staff ratios. Nursing
Standard, 17(34), 8-8.
Dotson, M. J., Dave, D. S., & Cazier, J. A. (2012). Addressing the nursing shortage: A
critical health care issue. Health Marketing Quarterly, 29(4), 311-328.
Duffield, C., Diers, D., O'Brien-Pallas, L., Aisbett, C., Roche, M., King, M., & Aisbett, K.
(2011). Nursing staffing, nursing workload, the work environment and patient
outcomes. Applied Nursing Research, 24(4), 244-255.
Ellis, P. A. (2013). A comparison of policies on nurse faculty workload in the United States.
Nursing Education Perspectives, 34(5), 303-309.
Foster, D. (2014). Leadership and nursing care management Huber Diane L leadership and
nursing care management 640pp £48.99 Elsevier fifth edition 9781455740710
1455740713. Nursing Management, 21(6), 13-13.

Technical English Essay 15
Harris, R. C., Rosenberg, L., & Grace O’Rourke, M. E. (2013). Addressing the challenges of
nursing student attrition. Journal of Nursing Education.
Hinno, S., Partanen, P., & Vehviläinen-Julkunen, K. (2011). Nursing activities, nurse staffing
and adverse patient outcomes as perceived by hospital nurses. Journal of Clinical
Nursing, 21(11-12), 1584-1593.
Iglesias, B., Ramos, F., Serrano, B., Fàbregas, M., Sánchez, C., García, M. J.,
Cebrian, H. M., Aragonés, R., Casajuana, J., & Esgueva, N. (2013). A randomized
controlled trial of nurses vs. doctors in the resolution of acute disease of low
complexity in primary care. Journal of Advanced Nursing, n/a-n/a.
Johansen, M. L., De Cordova, P. B., & Weaver, S. H. (2019). Nurse workforce environment
staffing councils: An innovative approach. Nurse Leader, 17(2), 141-146.
Juraschek, S. P., Zhang, X., Ranganathan, V., & Lin, V. W. (2011). United States registered
nurse workforce report card and shortage forecast. American Journal of Medical
Quality, 27(3), 241-249.
Ketefian, S., & Redman, R. W. (2015). A critical examination of developments in nursing
doctoral education in the United States. Revista Latino-Americana de Enfermagem,
23(3), 363-371.
Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings.
Rambam Maimonides Medical Journal, 6(2), e0016.
Lake, D. M., Allen, P. E., & Armstrong, M. L. (2016). Former military nurse officers: One
answer to the faculty shortage? Journal of Nursing Education, 55(5), 243-244.

Technical English Essay 16
MacLean, L., Hassmiller, S., Shaffer, F., Rohrbaugh, K., Collier, T., & Fairman, J. (2014).
Scale, causes, and implications of the primary care nursing shortage. Annual Review
of Public Health, 35(1), 443-457.
Munier, T., & Porter. (2014). The struggle for safe staffing levels in the USA: A political
economy of evidence-based practice. Journal of Research in Nursing, 19(7-8), 592-
603.
Nardi, D. A., & Gyurko, C. C. (2013). The global nursing faculty shortage: Status and
solutions for change. Journal of Nursing Scholarship, n/a-n/a.
Perhats, C., Keough, V., Fogarty, J., Hughes, N. L., Kappelman, C. J., Scott, M., &
Moretz, J. (2012). Non–violence-related workplace injuries among emergency nurses
in the United States: Implications for improving safe practice, safe care. Journal of
Emergency Nursing, 38(6), 541-548.
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital
nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs,
31(11), 2501-2509.
Thompson, M. C. (2012). Professional autonomy of occupational health nurses in the United
States. Workplace Health & Safety, 60(4), 159-165.
Wu, S., Singh-Carlson, S., Odell, A., Reynolds, G., & Su, Y. (2016). Compassion fatigue,
burnout, and compassion satisfaction among oncology nurses in the United States and
Canada. Oncology Nursing Forum, 43(4), E161-E169.
Wu, T., Fox, D. P., Stokes, C., & Adam, C. (2012). Work-related stress and intention to quit
in newly graduated nurses. Nurse Education Today, 32(6), 669-674.

Technical English Essay 17
Wyte-Lake, T., Tran, K., Bowman, C. C., Needleman, J., & Dobalian, A. (2013). A
systematic review of strategies to address the clinical nursing faculty shortage.
Journal of Nursing Education, 52(5), 245-252.
Zinn, J. L., Guglielmi, C. L., Davis, P. P., & Moses, C. (2012). Addressing the nursing
shortage: The need for nurse residency programs. AORN Journal, 96(6), 652-657.
Zolot, J. (2017). Ohio collaborative model proactively addresses the looming nursing
shortage. AJN, American Journal of Nursing, 117(6), 14.