“The stated goals of the profession of nursing are demonstrably ethical: to protect the patient from harm, to provide care that prevents complications, and to maintain a healing psychological environment for patients and families (Corley, 2002). ” The nursing staffing issues posed upon nurses today can create a state of moral distress. Moral distress is common “when there are insufficient numbers of staff, inadequately trained staff, and organizational policies and procedures that make it difficult, or even impossible, for nurses to meet the needs of patients and their families (Corley, 2002).
When faced with these situations, nurses not only have to keep in mind their roles and responsibility to meet the needs of the patients and families, they also have to balance this with the ethical and legal ramifications involved that may conflict with their own viewpoints, beliefs, and feelings. The nurse can be faced with the knowledge that there is an imbalance in the amount of patients and patient workload to the amount of nurses on hand to provide care. This unsafe nurse-to-patient ratio poses a quandary, a state of moral distress for the nurse. Patient safety is an essential and vital component of quality care (Ballard, 2003). ” We as nurses are taught to do no harm, but often we are put in circumstances that seem to be no-win for either the nurse or the patient. Patient safety, quality care, and positive patient outcomes as nurse’s aims are challenged when the nurse is faced with these dilemmas. “Nurse staffing levels and the organizational environment for nursing practice are independently predictive of patient outcomes (Aiken, 2002). If the nurse were to leave in this instance, the nurse could be charged with abandonment. Employers could even follow with “charges of insubordination and prompt disciplinary action” (Garvis, 2003). If the nurse were to stay, the nurse would be faced with an overwhelming patient load that would leave the patient potentially receiving sub-par care due to the disproportionate nurse-to-patient ratio. “Research has revealed that more registered nurses result in better patient outcomes (Smith, 2002). “The healthcare industry in this nation has long failed to appreciate that, in most health care settings, the main commodity that is being provided is nursing care (Ballard, 2003). ” Staff nurses are not the only nurses facing this ethical impasse. The ‘business side’ of healthcare is faced with “making decisions for allocation of resources to meet patient needs, including staffing levels and appropriate technology (Thorman, et al, 2006). ” Ultimately, everyone is responsible for the safety of the patient. All stakeholders are responsible to see that no harm occurs to patients. These stakeholders include: society in general, patients, individual nurses, nursing educators, administrators, and researchers, physicians, governments including legislative bodies and regulators, professional associations and accrediting agencies (Ballard, 2003). ” The Institute of Medicine (IOM) proposed six aims for improvement in the nation’s health care system, which they described in 1999 as “fractured, prone to errors, and detrimental to safe patient care. The six aims include: safety (avoiding injuries to patients from the care that is intended to help them); effective (providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit); patient-centered (providing care that is respectful of and responsive to patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions); timely (reducing waits and sometimes harmful delays for both those who receive and those who give care); efficient (avoiding waste, including waste of equipment, supplies, ideas, and energy); equitable (providing care that does not vary in quality because of personal characteristics such as gender, geographic location, and socioeconomic status (IOM, 2001). The American Nurses Association (ANA) testified before an IOM committee and stated, “it is time to address the ‘unholy trinity’ of patient injuries and health care errors, staffing shortages, and the looming nursing shortage” (ANA, 2002).
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