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Nursing Shortage: Milestone Two
Alfa Shrestha
Nursing, Southern New Hampshire University
NUR-300 Scholarly Inquiry
Professor Osmberg
May 24, 2023
Nursing Burnout: Milestone Two
This milestone will continue to look at the nursing practice issue of nursing shortage. The
aspects of healthcare that will be connected include legal implications, ethical implications, finance,
quality patient care, and nursing safety challenges.
Legal Implications
Nurses are the first line of patient care and should be responsible to prevent practice errors,
faulty diagnoses, wrong medicines, and other related caring issues (Tajabidi el at., 2020). The shortage
of nurses contributes to an increased workload, leading nurses to potentially resort to shortcuts that
compromise safety to overcome obstacles and complete tasks more efficiently (Andel el at., 2021). This
creates medication errors due to the high workload and inadequate time for proper documentation.
Electronic documentation can ideally reduce drug mistakes, support decision-making, and increase
patient participation in the process of care (Tajabidi el at., 2020).
Errors resulting in negative outcomes for patients are reported to state agencies and are
investigated depending on the severity of the event according to the Massachusetts Board of Nursing
(2023). Every state's Board of Nursing has established specific regulations and expectations that all
nurses are required to adhere to. In Massachusetts, nurses engage in behavior that is likely to harm the
health, safety, or welfare of the public. The Board of Nursing has the right to suspend or revoke a
nurse’s license for errors made that put the patient in harm’s way (MBON, 2023).
Ethical Implications
Nurses are ethically obliged to prioritize their own well-being and safety to guarantee the
delivery of safe patient care (Hossain & Clatty, 2021). This includes displaying a sense of duty to self, as
defined in the Code of Ethics for Nurses With Interpretive Statements “The nurse owes the same duties
to self as to others, including the responsibility to promote health and safety, preserve wholeness of
character and integrity” (American Nurses Association [ANA], 2021, p. 37). Nurses are faced with moral
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distress and ethical dilemmas while providing care for their patients and dealing with staffing shortages.
Increase workload has consequences for healthcare workers’ mental and physical health, and
precipitates burnout and job turnover (Härkänen el at., 2021; Kelly, Runge, & Spencer, 2015.) Managers
should strive to achieve a balance between understaffing and overstaffing, despite constantly changing
patient numbers, to assure high satisfaction of nursing staff (Saaiman el at., 2021).
Finance
Nursing shortages can lead to available nurses working overtime and overflowing job duties
which can attributed to high RN turnover (Gelina, 2022). The growing shortage of nurses and turnover
in nursing is expensive to organizations. It is estimated that nurses leaving a typical hospital cost
between $3.6 million and $6.5 million annually and that for every percent a hospital organization
improves retention, it may decrease annual turnover costs by $270 800 (Thompson el at., 2022). A
hospital with a high turnover rate can easily find itself with a financial burden of several million
dollars a year (Hopkins, 2022).
Quality Patient Care
According to Winter et al. (2020), research has shown that hospital staff shortages measured by
self-reports, vacancies, and turnover relate significantly to patient dissatisfaction with nursing care.
Patients are significantly less satisfied with their care when staffing ratios are low. The researchers
utilized the Weisse Liste database, which comprises aggregated results from a patient satisfaction survey
conducted through a questionnaire focused on the patients' experiences and empirical model which
provides subjective questionnaire to hospitals (Winter el at., 2020).
Empirical studies have shown that inadequate nurse staffing is linked to a higher occurrence of
missed care. This, in turn, has been associated with lower reported quality of nursing care and patient
safety, increased rates of adverse events and mortality, as well as reduced levels of patient satisfaction.
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The significant impact on patient care and satisfaction is evident through these adverse patient
outcomes. (Cho el at., 2019; Ball et al., 2017).
Nursing Safety Challenges
Nurses are required to work overtime due to a shortage of nursing staff or to provide
appropriate nursing services to meet the daily variations in patient census (Bae el at., 2022). Working for
long periods without sufficient rest can have a detrimental impact on the nurses (Bae el at., 2022; Min et
al., 2019). It is estimated 45% of Registered Nurses (RNs) in the United States worked more than 39
hours per week, and 19.3% of nurses worked 48 or more hours per week (Bae el at., 2022) The
consequences of working long hours are emotional exhaustion, depersonalization, physical injuries,
impaired sleep, and cognitive dysfunction (Bae el at., 2022; Shin et al., 2020). Heightened stress levels
lead to decreased job satisfaction, contributing to burnout and an increased turnover rate. The burden
on the remaining staff increases and the cycle continues, with many posts left unfilled (Härkänen el at.,
2019). According to Skillman & Tom (2022) healthcare organizations should establish a work
environment that fosters job satisfaction and promotes a sense of safety for nurses to deliver care
effectively. This can be achieved by implementing realistic patient-to-staff ratios and workloads that
allow for optimal patient and self-care (Skillman & Tom, 2022). Additionally, creating a supportive
atmosphere where nurses feel backed by their leaders is crucial (Skillman & Tom, 2022).
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References
American Nurses Association [ANA]. (2021). Nursing: Scope and standards of practice (4th ed.). Author
Andel, S. A., Tedone, A. M., Shen, W., & Arvan, M. L. (2021). Safety implications of different forms of
understaffing among nurses during the COVID 19 pandemic.‐ Journal of Advanced Nursing, 78(1).
https://doi.org/10.1111/jan.14952
Bae, S., Pen, M., Sinn, C., Kol, S., An, B., Yang, S. J., Rhee, H., Ha, J., & Bae, S. (2021). Work hours and
overtime of nurses working in Cambodian hospitals. International Nursing Review, 69.
https://doi.org/10.1111/inr.12720
Cho, S., Lee, J., You, S. J., Song, K. J., & Hong, K. J. (2019). Nurse staffing, nurses prioritization, missed
care, quality of nursing care, and nurse outcomes. International Journal of Nursing
Practice, 26(1). https://doi.org/10.1111/ijn.12803
Gelinas, L. (2022). The nursing shortage: this one is different. American Nurse Today, 17(7), 4.
Hopkins, M., Hossain-Wilson, J., Jimenez, R., Stephenson, C., Dimino, K., Wertz, B., & Avallone, J. (2022).
Retaining novice nurses. American Nurse Today, 17(9), 49–53.
Hossain, F., & Clatty, A. (2021). Self-care strategies in response to nurses’ moral injury during COVID-19
pandemic. Nursing Ethics, 28(1), 23–32.
https://doiorg.ezproxy.snhu.edu/10.1177/0969733020961825
Skillman, D., & Toms, R. (2022). Factors Influencing Nurse Intent to Leave Acute Care Hospitals. The
Journal of Nursing Administration, 52(12), 640–645.
https://doi.org/10.1097/nna.0000000000001225
Tajabadi, A., Ahmadi, F., Sadooghi Asl, A., & Vaismoradi, M. (2019). Unsafe nursing documentation: A
qualitative content analysis. Nursing Ethics, 27(5), 1213–1224.
https://doi.org/10.1177/0969733019871682
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Thompson, S. C., Holmgren, A. J., & Ford, E. W. (2020). Information system use antecedents of nursing
employee turnover in a hospital setting. Health Care Management Review, Publish Ahead of
Print. https://doi.org/10.1097/hmr.0000000000000308
Winter, V., Schreyögg, J., & Thiel, A. (2020). Hospital staff shortages: environmental and organizational
determinants and implications for patient satisfaction. Health Policy, 124(4), 380–388.
https://doi.org/10.1016/j.healthpol.2020.01.001
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